Quality Auditor - Davies Group : Job Details

Role Title: Quality Auditor – Claims Operations Niche and DER

Preston Office

Purpose of the Role:

To ensure the accuracy, compliance, and efficiency of claims processing within a claims operation environment by conducting audits, identifying trends, and driving continuous process improvement initiatives.

Key Responsibilities:

• Conduct regular audits of claims files to assess accuracy, completeness, and adherence to internal policies and regulatory standards.
• Identify errors, inconsistencies, or potential fraud, and escalate findings appropriately.
• Collaborate with claims handlers and team leaders to provide feedback and coaching based on audit results.
• Analyse audit data to identify systemic issues and recommend process enhancements.
• Develop and maintain audit tools, scorecards, and reporting dashboards.
• Support the implementation of corrective actions and monitor their effectiveness.
• Participate in cross-functional projects aimed at improving claims workflows and customer outcomes.
• Stay current with industry regulations, compliance requirements, and best practices.

Process Improvement Focus:

• Lead root cause analysis on recurring audit findings and inefficiencies.
• Partner with operational leaders to redesign workflows and eliminate waste.
• Contribute to the development of training materials and SOPs based on audit insights.
• Track and report on KPIs related to quality and process improvement.

Essential Skills & Experience:

• Experience in claims auditing within a TPA or insurance environment.
• Strong understanding of claims processes, regulatory compliance, and quality assurance principles.
• Analytical mindset with the ability to interpret data and identify trends.
• Excellent communication and interpersonal skills for delivering feedback and influencing change.
• Proficiency in audit software, claims management systems, and Excel.

Desirable Qualifications:

• Familiarity with FCA regulations and TCF (Treating Customers Fairly) principles.

Davies are committed to being a diverse and inclusive workplace. We welcome candidates of all genders, gender identity and expression, neurodiversity, sexual orientation, disability, physical appearance, body size, race, age, nationality, and belief (or lack thereof).

• Join us and enjoy our ever-evolving benefits, including but not limited to:
• Reward platform – discounts for over 800 retailers
• 25 days holiday (rising with service)
• Well-being centre
• Recognition programme
• Paid fertility appointments
• Fostering friendly employer
• Pension - matched contribution at 5%
• Life Assurance (4 x basic salary)
• Development, training, and professional qualification