Remote

QA Specialist - Stop Loss Claims - Remote

Symetra
paid holidays, sick time, 401(k)
United States
Sep 24, 2025
Symetra has an exciting opportunity to join our team as aQA Specialist for Stop Loss Claims! About the role In this role, you'll support training, auditing, and performance monitoring for our Stop Loss Claims team. You'll help develop and maintain training programs, review high-dollar claims, and ensure consistent service quality. This role plays a key part in identifying improvement opportunities and supporting a culture of learning and accountability. What You'll Do Review and approve high-dollar claims beyond examiner authority levels, ensuring accuracy and timeliness. Audit claims to identify trends and errors, supporting training and process improvements. Collaborate with Process Owners to develop and update training programs for new and existing team members. Maintain and distribute reference materials, including training manuals and adjudication guidelines. Monitor department performance and prepare reports to support service goals. Review and approve policyholder plan documents and amendments prior to contract issuance. Draft plan document approval letters for compliance verification. Prepare quarterly QA reports for management review. Participate in implementation meetings for new and renewal business. May process specialized claims (specific, aggregate, reinsurance). Support internal audits and special projects as needed. Stay informed on industry trends and collaborate with legal and compliance teams as necessary. Why Work at Symetra Here's what some of our employees have to say about why they work at Symetra: "My advice to anyone considering a role at Symetra is to take full advantage of the incredible benefits offered-many of which are available on a near-daily basis. From inclusive groups like Women in Numbers to our Lunch and Learn Consortiums, these opportunities go beyond the job itself. Whether you're in an entry-level position or executive leadership, these programs are a fantastic way to connect, grow, and learn about other areas of the company." - Sandra A., Sr. Account Manager "Symetra is truly a great place to work. The positive work climate, strong sense of team, and the resources available make it feel like one cohesive family. What stands out most to me is the company's deep commitment to diversity, equity, and inclusion-it's not just a statement, it's an active and ongoing priority that's felt throughout the organization." -Charlotte G., Sr. Underwriter - Consultant Stop Loss What we offer you Benefits and Perks We don't take a "one-size-fits-all" approach when it comes to our employees. Our programs are designed to make your life better both at work and at home. Flexible full-time or hybrid telecommuting arrangements Plan for your future with our 401(k) plan and take advantage of immediate vesting and company matching up to 6% Paid time away including vacation and sick time, flex days and ten paid holidays Give back to your community and double your impact through our company matching Want more details? Check out our Symetra Benefits Overview Compensation Salary Range: $64,200 - $106,900 plus eligibility for annual bonus program Who You Are High school diploma or GED required, bachelor's degree in business administration or related field preferred. Minimum 3 years of experience in stop-loss or reinsurance claim auditing. Working knowledge of medical terminology, ICD-9/10, CPT coding, UB-92, HCFA forms. Expertise in stop-loss claims adjudication and plan document interpretation. Excellent analytical skills and attention to detail. Strong communication skills-written, verbal, and presentation. Proven ability to coach and provide constructive feedback. Proficient in Microsoft Office; experience with David Young/ESL systems a plus. Industry certifications a plus. Some minimal travel required. Please review Symetra's Remote Network Minimum Requirements: As a remote-first organization committed to providing a positive experience for both employees and customers, Symetra has the following standards for employees' internet connection: Minimum Internet Speed: 100 Mbps download and 20 Mbps upload, in alignment with the FCC's definition of "broadband." Internet Type: Fiber, Cable (e.g., Comcast, Spectrum), or DSL. Not Permissible: Satellite (e.g., Starlink), cellular broadband (hotspot or otherwise), any other wireless technology, or wired dial-up. When applying to jobs at Symetra you'll be asked to test your internet speed and confirm that your internet connection meets or exceeds Symetra's standard as outlined above. We empower inclusion At Symetra, we aspire to be the most inclusive insurance company in the country. We're building a place where every employee feels valued, respected, and has opportunities to contribute. Inclusion is about recognizing our assumptions, considering multiple perspective, and removing barriers. We accept and celebrate diverse experiences, identities, and perspectives, because lifting each other up fuels thought and builds a stronger, more innovative company. We invite you to learn more about our efforts here. Creating a world where more people have access to financial freedom Symetra is a national financial services company dedicated to helping people achieve their financial goals and feel confident about the future. In our daily work, we're guided by the principles of Value, Transparency and Sustainability. This means we provide products and services people need at a competitive price, we communicate clearly and openly so people understand what they're buying, and we design products-and operate our company-to stand the test of time. We're committed to showing up for our communities, lifting up our employees, and standing up for diversity, equity and inclusion (DEI). Join our team and help us create a world where more people have access to financial freedom. For more information about our careers visit https://symetra.eightfold.ai/careers Work Authorization Employer work visa sponsorship and support are not provided for this role. Applicants must be currently authorized to work in the United States at hire and must maintain authorization to work in the United States throughout their employment with our company. #LI-NW1 #LI-Remote