Role Description Plan and conduct independent audits to assess compliance with regulations, guidelines, and operating procedures. Prepare and distribute reports of findings to supervisor, operations staff, management, and customers. Provide consultation in interpretation of regulations, guidelines, policies, and procedures. Support management in promotion and assessment of compliance to regulations, guidelines and corporate policies. Essential Functions - Plan, schedule, conduct, report and close audit activities in any of the countries involved with IQVIA contracts to assess compliance with applicable regulations/guidelines, customer requirements, IQVIA SOPs and project specific guidelines/instructions. - Evaluate audit findings and prepare and distribute reports to operations staff, management, and customers. - Provide interpretation and consultation to project teams on regulations, guidelines, compliance status, and policies and procedures. - Provide consultation to customers and monitors in interpretation of audit observations and formulation of corrective action plans. - Manage Quality Issues. - Present educational programs and provide guidance to operational staff on compliance procedures. - Review, approve investigations, Root Cause Analysis (RCA), Corrective Action Prevention (CAPA) and Effectiveness Check (EC) plans and track till closures for quality events arising from Quality Issues, Audits, Inspections or during similar QA activities. - Provide quality assurance consultancy activities and projects for clients within budget and established timelines. - Evaluate policies and procedures for compliance with applicable regulations/guidelines and provide recommendations to management for continuous process improvements. - Host audits/inspections, ensure proper conduct of customer-initiated audits and mock regulatory inspections, and assist in regulatory facility inspections. - May perform GLP Archivist duties where needed. - Manage/oversee quality events updates in eQMS and/or maintain the electronic quality management system (eQMS) and provide support in relation to the audit lifecycle. - Lead/collaborate/support in QA initiatives/projects for quality, process improvements. - Assist in training of new Quality Assurance staff. Qualifications - Bachelor's Degree (Preferred). - 5 years experience in pharmaceutical, technical, or related area, of which 3 years in Quality Assurance. GXP experience. Equivalent combination of education, training and experience. - Knowledge of word-processing, spreadsheet, and database applications. - Extensive knowledge of pharmaceutical research and development processes and regulatory environments. - Knowledge of quality assurance processes and procedures. - Strong interpersonal skills. - Excellent problem solving, risk analysis and negotiation skills. - Strong training capabilities. - Effective organization, communication, and team orientation skills. - Ability to initiate assigned tasks and to work independently. - Ability to manage multiple projects. - Ability to establish and maintain effective working relationships with coworkers, managers and clients. Benefits - The potential base pay range for this role, when annualized, is $84,000.00 - $139,900.00. - The actual base pay offered may vary based on a number of factors including job-related qualifications such as knowledge, skills, education, and experience; location; and/or schedule (full or part-time). - Dependent on the position offered, incentive plans, bonuses, and/or other forms of compensation may be offered, in addition to a range of health and wellness and/or other benefits. Company Description IQVIA is a leading global provider of clinical research services, commercial insights and healthcare intelligence to the life sciences and healthcare industries. We create intelligent connections to accelerate the development and commercialization of innovative medical treatments to help improve patient outcomes and population health worldwide.

• Utilize retail experience to perform audit procedures, identifying and defining issues. • Identify and validate over and under-payments of claims. • Enter claims into Cotiviti's system accurately in accordance with standard procedures. • Update current reports, develop and run custom queries, and validate report accuracy. • Provide verification of claims validation in a concise written manner.

Pie's mission is to empower small businesses to thrive by making commercial insurance affordable and as easy as pie. We leverage technology to transform how small businesses buy and experience commercial insurance. Like our small business customers, we are a diverse team of builders, dreamers, and entrepreneurs who are driven by core values and operating principles that guide every decision we make. The Claims Quality Assurance Auditor will conduct regular audits and assessments of Pie's claims handling processes to ensure adherence to Claims Best Practices, regulatory standards, and internal guidelines. This role is responsible for reviewing claim files for compliance, identifying areas of non-compliance, and recommending corrective actions to improve claims quality. The auditor will collaborate with Claims teams, prepare detailed audit reports, and support the development of quality control policies and training programs that drive continuous improvement in claims performance and ensure regulatory compliance. How You’ll Do ItClaims Audit & Assessment: - Collaborate with Claims leadership to design, refine, and continuously improve the quarterly audit program and scoring methodology, ensuring alignment with operational realities while maintaining regulatory defensibility. - Partner with Claims to define: - Weighted scoring criteria - High-risk violation thresholds - File sampling strategy - Performance benchmarks tied to ≥95% compliance targets - Ensure the audit program reflects evolving statutory requirements, regulator audit trends, and internal risk drivers. - Conduct regular monthly and quarterly audits and assessments of quality management systems and claims handling processes - Review claim files to verify compliance with regulatory standards, statutory requirements, and internal guidelines - Evaluate claims for adherence to Pie's Claims Best Practices and quality standards - Assess claim documentation, investigation techniques, reserve adequacy, and settlement practices - Identify areas of non-compliance and recommend corrective actions to address deficiencies - Apply weighted scoring methodology to measure compliance performance and identify systemic risk patterns. - Apply established audit methodologies and sampling techniques to ensure comprehensive evaluations Documentation & Reporting: - Document monthly and quarterly audit findings with clear, detailed explanations of deficiencies and best practices observed - Prepare comprehensive audit reports for management that include findings, recommendations, and action items - Analyze data to identify trends, patterns, and areas for improvement across the claims organization - Provide timely feedback to adjusters and Claims leadership on audit results - Maintain accurate records of all audits, findings, and corrective action plans Quality Control & Process Development: - Collaborate with various departments to ensure quality standards are met consistently - Develop and update quality control policies and procedures based on audit findings and regulatory changes - Assist in developing quality assurance goals and objectives aligned with department strategies - Recommend process improvements to enhance claims quality and operational efficiency - Support the implementation of new quality standards and best practices Compliance & Corrective Action Monitoring - Monitor the implementation and effectiveness of corrective and preventive actions - Track remediation efforts to ensure deficiencies are addressed in a timely manner - Verify that corrective actions result in sustained improvements in claims quality - Coordinate with external auditors and facilitate external audit processes when needed - Stay current with regulatory changes and industry best practices that impact claims quality Training & Knowledge Sharing: - Train staff on quality assurance policies, procedures, and industry best practices - Provide coaching and guidance to adjusters on claim handling techniques and compliance requirements - Conduct training sessions on common audit findings and remediation strategies - Share knowledge of regulatory requirements and Claims Best Practices with Claims teams - Support Claims Learning & Development initiatives with quality-focused training content Cross-Functional Collaboration: - Partner with Claims Adjudication team to address quality issues and implement improvements - Work with Claims Regulatory Compliance team to ensure audits capture all compliance requirements - Collaborate with Claims Learning & Development team to develop targeted training based on audit findings - Coordinate with Claims Data & Analytics team to support quality reporting and trend analysis - Communicate with Claims leadership on quality trends and recommended actions The Right StuffRequired Experience & Education: - High School diploma or GED required; Bachelor's degree in Business Administration, Risk Management, or related field preferred - 5+ years of workers' compensation claims experience with strong understanding of claim handling practices - 2+ years of experience in claims auditing, quality assurance, or compliance roles preferred - Strong knowledge of Claims Best Practices and regulatory requirements across multiple jurisdictions - Experience conducting claim file reviews and documenting audit findings The use of AI in Application Review: To support a fair, efficient, and consistent hiring process, we use AI-powered tools to assist in the initial screening of applications. These tools help us identify qualifications and prior work experiences that align with the requirements of the role. We may also use AI assistant video tools during interviews to support note-taking and candidate evaluation. All AI-powered outputs are still subject to human oversight and decision-making at multiple stages of the process. By submitting your application, you acknowledge and consent to Pie utilizing these AI technologies to assist in our evaluation process. Base Compensation Range $75,000—$95,000 USD Compensation & Benefits - Competitive cash compensation - A piece of the pie (in the form of equity) - Comprehensive health plans - Generous PTO - Future focused 401k match - Generous parental and caregiver leave - Our core values are more than just a poster on the wall; they’re tangibly reflected in our work Our goal is to make all aspects of working with us as easy as pie. That includes our offer process. When we’ve identified a talented individual who we’d like to be a Pie-oneer , we work hard to present an equitable and fair offer. We look at the candidate’s knowledge, skills, and experience, along with their compensation expectations and align that with our company equity processes to determine our offer ranges. Each year Pie reviews company performance and may grant discretionary bonuses to eligible team members. Location Information Unless otherwise specified, this role is remote. Remote team members must live and work in the United States (territories excluded) and have access to reliable, high-speed internet. Additional InformationPie Insurance is an equal opportunity employer. We do not discriminate on the basis of race, color, religion, sex, sexual orientation, gender identity, marital status, age, disability, national or ethnic origin, military service status, citizenship, or other protected characteristic. Pie Insurance participates in the E-Verify program. Please click here, here and here for more information. Pie Insurance is committed to protecting your personal data. Please review our Privacy Policy. Safety First: Pie Insurance is committed to your security during the recruitment process. We will never ask you for credit card information or ask you to purchase any equipment during our interview or onboarding process. Pie Named to 2025 America's Best Startup Employers Pie Insurance 2025 State of Workplace Safety Report #LI-REMOTE #BI-REMOTE

• Review and audit medical claims for accuracy and compliance with company policies and benefit plan parameters. • Listen to customer service phone calls for accuracy and professionalism. • Provide feedback, coaching, and mentoring to claims and customer service staff members on results, best practices and compliance issues. • Assist in training efforts as needed. • Prepare summary and detailed reports on audit findings, trends, and recommendations for process enhancements. • Stay updated on industry changes in medical coding, billing regulations, and insurance policies. • Assist in developing and implementing audit policies and procedures. • Measure and report on performance guarantee results.