Quality Audit Analyst - DGD

Dearborn Group
US - Maine - Portland
January 8, 2025

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!Pay Transparency Statement:

At Dearborn, you will be part of an organization committed to offering meaningful benefits to our employees to support their life outside of work. From health and wellness benefits, 401(k) savings plan, pension plan, paid time off, paid parental leave, disability insurance, supplemental life insurance, employee assistance program, paid holidays, tuition reimbursement, plus other incentives, we offer a robust total rewards package for associates.

The compensation offered will vary depending on your job-related skills, education, knowledge, and experience. This role aligns with an annual incentive bonus plan subject to the terms and the conditions of the plan.

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
$40,900.00 - $91,000.00

Read the full job description and apply online on the recuiter's web-site

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