Quality Audit Analyst

3 days ago

Lombard, Illinois, United States Health Care Service Corporation Full time

At HCSC, we consider our employees the cornerstone of our business and the foundation to our success. We enable employees to craft their career with curated development plans that set their learning path to a rewarding and fulfilling career.

Come join us and be part of a purpose driven company who is invested in your future

Job Summary

This position is responsible for planning and conducting detailed audits, analyzing programs, conducting training, coaching and managing projects related to quality. Review claims, new business, changes, terminations, 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) 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 THE 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


HCSC Employment Statement:

HCSC is committed to diversity in the workplace and to providing equal opportunity and affirmative action to employees and applicants. We are an Equal Opportunity Employment / Affirmative Action employer dedicated to workforce diversity and a drug-free and smoke-free workplace. Drug screening and background investigation are required, as allowed by law. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or protected veteran status.

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