[Hiring] Senior Claims Oversight Analyst @Independence Pet Group

Role Description

The Senior Carrier Operations Claims Analyst (Carrier Operations Quality Claims Senior Analyst) provides oversight of delegated claims operations and serves as a subject matter expert for complex claims, coverage interpretation, appeals, and escalated claim matters. This role partners with internal stakeholders and third-party administrators to ensure claims are handled consistently, compliantly, and in accordance with carrier guidelines.

Key Responsibilities

• Claims Oversight & Governance:
  • Review and provide recommendations on high-dollar, complex, and over-authority claims.
  • Evaluate coverage determinations, appeals, exceptions, and other escalated claim matters.
  • Identify claim trends, operational risks, and opportunities for improvement across administrator partners.
• Carrier Oversight:
  • Support audits, market conduct examinations, regulatory inquiries, and corrective action initiatives.
  • Monitor administrator compliance with carrier requirements, policies, and regulations.
  • Assist with fraud-related investigations, reporting, and risk mitigation activities.
• Operational Excellence:
  • Analyze claims data, audits, and operational metrics to improve performance and outcomes.
  • Review administrator workflows, procedures, and controls for effectiveness and compliance.
  • Partner with stakeholders to implement process improvements and corrective action plans.
• Documentation & Program Support:
  • Develop and maintain claims guidelines, governance standards, and operational procedures.
  • Support ongoing enhancements to claims oversight and governance programs.
  • Communicate policy updates, claims guidance, and operational requirements to stakeholders.
• Leadership & Collaboration:
  • Serve as a subject matter expert for claims oversight and delegated claims administration.
  • Provide guidance, training, and support to team members and business partners.
  • Participate in projects and initiatives that strengthen carrier operations and claims governance.

Qualifications

• 5+ years of insurance claims, claims operations, compliance, quality, or related experience.
• Strong knowledge of claims handling, coverage interpretation, and regulatory requirements.
• Excellent analytical, problem-solving, communication, and stakeholder management skills.

Preferred Qualifications

• Experience working with TPAs, delegated authority programs, or carrier oversight functions.
• Experience supporting audits, compliance initiatives, fraud investigations, or process improvements.
• Bachelor’s degree in Business, Insurance, Risk Management, or a related field.

Core Competencies

• Claims Oversight & Governance
• Regulatory Compliance & Risk Management
• Coverage Analysis & Problem Solving
• Process Improvement & Operational Excellence
• Communication & Business Partnership

Benefits

• Comprehensive full medical, dental and vision Insurance
• Basic Life Insurance at no cost to the employee
• Company paid short-term and long-term disability
• 12 weeks of 100% paid Parental Leave
• Health Savings Account (HSA)
• Flexible Spending Accounts (FSA)
• Retirement savings plan
• Personal Paid Time Off
• Paid holidays and company-wide Wellness Day off
• Paid time off to volunteer at nonprofit organizations
• Pet friendly office environment
• Commuter Benefits
• Group Pet Insurance
• On the job training and skills development
• Employee Assistance Program (EAP)