Claims Auditor / Quality Assurance Specialist

Claims Auditor / Quality Assurance Specialist

Insurance Claims Auditor / Quality Assurance Specialist

SX3 Claims Limited is a leading independent specialist management consultancy providing expert audit, oversight, and advisory services to insurers, MGAs, and TPAs across the UK general insurance market. We are seeking a highly analytical and detail-oriented professional to join our consultancy team as an Insurance Claims Auditor and/or Quality Assurance (QA) Specialist.

In this client-facing role, you will deliver independent assurance over claims handling performance, assess operational controls, and provide actionable recommendations to improve quality, compliance, and customer outcomes. You will work across a range of insurance lines and client types, with a particular focus on engagements for insurance companies and MGAs. Your work will support SX3’s mission to raise standards and reduce risk in claims operations across the market.

Key Responsibilities

• Conduct independent audits of open and closed claims files to assess accuracy, compliance with policy terms, and adherence to FCA and Consumer Duty requirements.
• Evaluate the effectiveness of client claims handling processes, including triage, investigation, reserving, settlement, and customer communication.
• Identify discrepancies, control weaknesses, and potential fraud indicators, and document findings with clear evidence and rationale.
• Analyse audit results to identify trends, recurring issues, and systemic risks across client operations.
• Prepare detailed audit reports and executive summaries, including RAG-rated findings and practical recommendations.
• Support the development and refinement of client QA frameworks, audit programmes, and performance metrics.
• Provide feedback and coaching to client claims teams, either directly or via client management, to support continuous improvement.
• Contribute to the design and delivery of training materials, calibration sessions, and quality improvement workshops.
• Maintain up-to-date knowledge of UK insurance regulations, market practices, and emerging risks to ensure audit criteria remain current and relevant.
• Represent SX3 in client meetings, governance forums, and regulatory reviews as a subject matter expert in claims quality and audit.

Required Qualifications and Skills

• Strong understanding of UK general insurance claims processes across multiple lines (e.g. motor, property, liability, travel).
• In-depth knowledge of FCA regulatory requirements, including ICOBS, SYSC, PRIN, and Consumer Duty.
• Proven experience in claims auditing, quality assurance, or technical claims handling (minimum 3 years).
• Excellent analytical skills and attention to detail, with the ability to interpret complex claim scenarios and identify control gaps.
• Strong written and verbal communication skills, including the ability to produce high-quality reports and present findings to senior stakeholders.
• Proficiency in Microsoft Excel, Word, and claims management systems; experience with audit tools or QA platforms is advantageous.
• Professional integrity, objectivity, and the ability to manage sensitive information with discretion.
• Ability to work independently and manage multiple client assignments simultaneously.
• ACII, Dip CII, or equivalent professional qualification preferred; additional certifications (e.g. CFE, CIA, Six Sigma) are desirable.

Preferred Experience

• Experience working for an insurance company, managing general agent (MGA), or third-party administrator (TPA).
• Exposure to operational governance, risk management, or compliance functions within insurance.
• Involvement in the design or implementation of claims QA frameworks or audit methodologies.
• Experience supporting regulatory reviews or preparing for FCA/thematic audits.
• Familiarity with international claims standards or cross-border claims handling (e.g. travel, medical, or reinsurance claims).
• Additional European language skills, in addition to English.

Why Join SX3?

At SX3, you’ll work alongside experienced consultants on high-impact projects that shape the future of claims operations. You’ll gain exposure to a wide range of clients and claim types, contribute to industry-leading audit programmes, and help drive measurable improvements in quality and compliance. We offer a collaborative, intellectually stimulating environment where your expertise will be valued and your development supported.

Seniority level

• Mid-Senior level

Employment type

• Full-time

Job function

• Finance and Sales

Industries

• Insurance

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