Senior Quality Insight Specialist

Job Classification:

Operations - Insurance Operations

The Claim Management Quality Insights Specialist plays a pivotal role in elevating disability claims performance by conducting qualitative, pattern-based reviews that extend beyond traditional transactional QR programs. This role is dedicated to independently assessing the behaviors, activities, and strategies that drive optimal claim outcomes and accelerate claim management skills across the organization—providing actionable insights, trending and analysis, and recommendations that accelerate continuous improvement across the claim organization.

This will be a hybrid role based out of Newark NJ, Fort Washington, PA. or Shelton, CT. For exceptionally well-qualified candidates, Virtual working arrangement may be considered, with expectation of travel as required.

Key Responsibilities

• Independently review a prescribed volume of long-term disability claims to assess claim management behaviors and real-world application of knowledge and skills.
• Synthesize findings into clear, actionable insights and recommendations for both individuals and teams.
• Prepare summary and drilldown reports for leaders, highlighting strengths, recurring opportunities, and system-wide trends.
• Participate in feedback and coaching conversations to translate review insights into practical next steps for claim professionals and leadership.
• Collaborate with Ops Excellence, Claims Leadership, and Learning & Development to ensure that outputs rapidly inform training, process refinement, and leadership coaching.
• Contribute to the ongoing development of the program’s review tools, rubrics, and dashboards.
• Remain objective and proactive in surfacing both best practices and barriers to success, always aiming to drive measurable improvement.

Required Skills & Qualifications

• 5+ years of hands-on, complex experience in LTD claim management
• Exceptional claim/risk management skills and technical knowledge in contract interpretation and administration
• Strong presentation and facilitation skills
• Excellent organizational and time management skills
• Ability to exercise sound judgment
• Goal oriented with an ability to organize and analyze information
• Strong critical thinking skills, communication, organization, and time management skills
• Demonstrated expertise in behavior-based review, pattern recognition, and root cause analysis
• Ability to connect process steps and behaviors to broader business outcomes and performance metrics
• Experience providing actionable, constructive feedback, consultation and coaching for professional growth
• Strong written and verbal communication skills; adept at tailoring messages for diverse audiences
• Collaborative, influential, and comfortable working and negotiating cross-functionally
• Consistently strong engagement and critical thinking to drive effective problem solving and high-quality claims management to benefit overall customer experience
• Demonstrated ability to adapt to the changing needs of an organization
• Proficiency with Microsoft Office Suite (Word, Excel, PowerPoint, Outlook, Teams)
• Bachelor’s degree or equivalent relevant experience required

Core Competencies

• Continuous Improvement Mindset: Proactively seeks opportunities for process, behavioral, and outcome improvement; embraces learning and adapts quickly to new information or change.
• Change Management: Effectively encourages adoption of best practices and new approaches without direct supervisory power; guides others through change by building understanding, buy-in, and momentum.
• Analytical Acumen: Synthesizes qualitative and quantitative data to identify root causes, patterns, and actionable insights; able to see the “big picture” while attending to important details.
• Coaching & Feedback: Delivers constructive, actionable feedback in a way that motivates growth and builds capability at both the individual and team level.
• Communication & Storytelling: Distills complex findings into clear, compelling narratives for diverse audiences—translating insights into action.
• Collaboration & Partnership: Builds strong relationships and credibility across team and organizati