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Gallagher • Dallas, Texas, United States
Role & seniority: Senior leadership/management role in claims, focusing on fraud review within workers’ compensation. Requires leadership experience and claims expertise.
Stack/tools: MS Office; claims systems; data & analytics tools; familiarity with controls, SOPs, documentation standards; cross-functional collaboration with IT, Operations, Financial Controls.
Lead and develop a claims team responsible for identifying, reviewing, and escalating internal fraud; set performance expectations and quality standards.
Guide on complex claims, monitor trends, refine detection strategies, and ensure documentation integrity; implement QA checks.
Drive process optimization and controls; collaborate to strengthen system-based controls and investigative workflows; manage reporting on fraud trends and outcomes.
Bachelor’s degree; 9+ years claims handling experience (workers’ compensation) with auditing background.
Strong process management, fraud risk assessment, and QA capabilities.
Proficiency in MS Office and related claims/business software; ability to analyze data and guide cross-functional teams.
Jurisdictional knowledge in CA, OR, or NY; openness to other jurisdictions; familiarity with claims systems, controls, and data environments.
Experience in policy/process development (SOPs), escalation paths, and KPI tracking.
Location & work type: Remote 100%; preferred candidates with
Introduction
At Gallagher Bassett, we're there when it matters most because helping people through challenging moments is more than just our job, it’s our purpose. Every day, we help clients navigate complexity, support recovery, and deliver outcomes that make a real difference in people’s lives. It takes empathy, precision, and a strong sense of partnership—and that’s exactly what you’ll find here. We’re a team of fast-paced fixers, empathetic experts, and outcomes drivers — people who care deeply about doing the right thing and doing it well. Whether you're managing claims, supporting clients, or improving processes, you’ll play a vital role in helping businesses and individuals move forward with confidence. Here, you’ll be supported by a culture that values teamwork, encourages curiosity, and celebrates the impact of your work. Because when you’re here, you’re part of something bigger. You’re part of a team that shows up, stands together, and leads with purpose.
Overview
Ideal candidates will have Leadership experience in Workers' Compensation, jurisdictional knowledge and expertise preferred in California (CA), Oregon (OR), or New York (NY) (Northeast region). Open to all other jurisdictions. Remote 100%.
How you'll make an impact
Leadership & Team Management Lead, mentor, and develop a team of claims professionals responsible for identifying, reviewing, and escalating potential internal fraud. Establish clear performance expectations, workflows, and quality standards to ensure accuracy, consistency, and timeliness of fraud reviews. Foster a culture of integrity, accountability, and continuous improvement across the team. Claims Expertise & Quality Assurance Provide guidance on complex claims scenarios to ensure reviewers accurately identify red flags, anomalies, and deviations from expected handling. Monitor claim patterns, trends, and behaviors leveraging data, system cues, and review insights to refine detection strategies. Willing to develop familiarity and knowledge of claims system processes, controls, and data environment to support fraud reviews. Implement quality assurance checks to validate the completeness and integrity of case documentation. Process Optimization & Controls Share subject matter expertise to fraud risk assessments and recommendations to enhance existing controls to reduce risk across claims operations Collaborate with Financial Controls, Operations, , and IT to strengthen system‑based controls, triggers, and investigative workflows. Develop and maintain SOPs, escalation paths, and documentation standards for all fraud review activities. Reporting & Analytics Oversee timely reporting on fraud trends, case outcomes, and emerging risks to senior leadership. Use data to identify root causes and partner with cross‑functional teams to implement corrective actions. Track team metrics and KPIs to measure effectiveness and drive continuous improvement in payment review processes.
About You
Required: Bachelor's degree; 9 years relevant claims handling experience in addition to proficiency in MS Office applications, and related claims and business software.
Previous auditing experience in addition to extensive workers compensation claims background and strong process management skills.
#LI-JA1 #REMOTE
Compensation and benefits
We offer a competitive and comprehensive compensation package. The base salary range represents the anticipated low end and high end of the range for this position. The actual compensation will be influenced by a wide range of factors including, but not limited to previous experience, education, pay market/geography, complexity or scope, specialized skill set, lines of business/practice area, supply/demand, and scheduled hours. On top of a competitive salary, great teams and exciting career opportunities, we also offer a wide range of benefits.