Quality Audit Analyst - DGD

Posted 15 Hours Ago
Be an Early Applicant
South Portland, ME
40K-89K Annually
Junior
Insurance
The Role
The Quality Audit Analyst is responsible for planning and conducting audits, analyzing quality-related processes, and conducting training. They ensure adherence to internal controls, and process accuracy in claims and billing, additionally managing projects and collaborating with other teams.
Summary Generated by Built In

At Dearborn, our employees are the cornerstone of our business and the foundation to our success. We empower employees with curated development plans that foster growth and promote rewarding, fulfilling careers.

Join HCSC and be part of a purpose-driven company that will invest in your professional development.

Job Summary

This position is responsible for planning and conducting detailed audits, analyzing programs, conducting training, coaching and managing projects related to quality. Review new business, changes, terminations, claims, customer telephone calls, billing, premium application, and commission processes to assure that: a) Internal controls and Model Audit Rule requirements are adhered to b) Processing is performed timely, accurately, and completely in the appropriate systems, and c) Disability coding and liability decisions are accurate, utilizing all appropriate risk resources.

JOB REQUIREMENTS:

  • Bachelor’s degree or equivalent of 4 years of life and/or group disability insurance industry job experience.
  • Analytical and research skills.
  • Disability knowledge of NAIC, ERISA, and state regulations.
  • Technical claims expertise and accuracy in product knowledge of life, AD&D, STD, and LTD.
  • Technical claims expertise and accuracy in knowledge of group life and disability contracts.
  • Ability to work independently and within a team environment.
  • Applies best practices and knowledge of internal/external business challenges to improve products, processes, or services.
  • Solves complex problems; takes a new perspective on existing solutions to improve performance and efficiency.
  • Works to build consensus with internal/external peers in customer, and/or regulatory organizations.
  • Proven ability to work well in a high visibility environment.
  • Clear and concise written and verbal communication skills.
  • Experience in making complex decisions independently, with minimal supervision.
  • Organizational and multi-tasking skills to manage daily work load and meet aggressive deadlines and timetables.
  • Knowledge of state contract provisions.
  • Knowledge with sold case materials, departmental documents.
  • PC proficiency to include Word, Excel and lotus Notes.
  • Ability to demonstrate flexibility.
  • Ability to effectively manage conflict.
  • Ability to provide direct and candid feedback effectively while maintaining strong partnerships.

PREFERRED JOB REQUIREMENTS:

  • 1 year of experience in the FDL environment.
  • Experience with the following systems: Genelco, Enterprise Content Management (ECM), EAS, DCS, STAR
  • Minimum of 2 years of Group Life/Disability claims adjudication background.

THIS IS A FLEX ROLE WORKING 3 DAYS IN OFFICE 2 DAYS FROM HOME

#LI-HYBRID


    Are you being referred to one of our roles? If so, ask your connection at HCSC about our Employee Referral process!


    Dearborn Group Employment Statement:

    We are an Equal Opportunity Employment / Affirmative Action employer dedicated to providing an inclusive workplace where the unique differences of our employees are welcomed, respected, and valued. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, protected veteran status, or any other legally protected characteristics.

    Base Pay Range$39,900.00 - $88,800.00

    Top Skills

    Excel
    The Company
    HQ: Lombard, IL
    308 Employees
    On-site Workplace

    What We Do

    Dearborn Group is the trade name for Dearborn Life Insurance Company. Since 1969, we have been providing ancillary benefits to employer groups across the country.

    When combined with medical coverage, our suite of employer-paid and voluntary insurance solutions—life, short- and long-term disability, vision, critical illness and accident insurance—creates a comprehensive benefits package and gives employers, their employees, and their families complete peace of mind.

    Dearborn Group insurance products are issued by Dearborn Life Insurance Company, 701 E. 22nd St. Suite 300, Lombard, IL 60148.

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