Quality Audit Analyst - DGD

Health Care Service Corporation

Jun 21

Applications are closed

Job
Full-time
Junior & Mid Level
Data
Portland, +2

Requirements

Bachelor’s degree or equivalent of 4 years of 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 Disability claims adjudication background.

Responsibilities

This position is responsible for planning and conducting detailed audits, applying premium to groups, analyzing discrepancies, collaborating with Account Management and Sales, conducting training and managing projects related to quality. Review 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, and b) Processing is performed timely, accurately, and completely in the appropriate systems.

FAQs

What is the role of a Quality Audit Analyst at HCSC?

The Quality Audit Analyst at HCSC is responsible for conducting quality audits of various processes and operations to ensure compliance with company standards and regulations.

What are the key responsibilities of a Quality Audit Analyst at HCSC?

Some of the key responsibilities of a Quality Audit Analyst at HCSC include analyzing data, identifying trends, conducting audits, providing recommendations for improvement, and ensuring compliance with company policies and procedures.

What are the qualifications required to become a Quality Audit Analyst at HCSC?

Qualifications for a Quality Audit Analyst at HCSC may include a bachelor's degree in a related field, experience in audit or quality assurance roles, strong analytical skills, attention to detail, and the ability to communicate effectively.

What career development opportunities are available for a Quality Audit Analyst at HCSC?

At HCSC, we offer curated development plans for employees to set their learning path and advance their careers. Quality Audit Analysts may have opportunities for advancement within the company based on performance and qualifications.

Health Care Service Corporation

Empowering Whole Person Health With Compassion and Innovation

Science & Healthcare

Industry

10,001+

Employees

Mission & Purpose

Health Care Service Corporation, a Mutual Legal Reserve Company (HCSC), is an Independent Licensee of the Blue Cross and Blue Shield Association. We are the largest customer-owned health insurer in the United States, serving more than 18.6 million members through our Plans in Illinois, Montana, New Mexico, Oklahoma, and Texas. For nearly a century, we have enabled and coordinated the access to quality care for millions of members. Our experience and industry knowledge establishes a solid foundation for our future—driving innovations that further expand access, improve health outcomes, and reduce costs. Embedded within the fabric of how we operate is a deep sense of caring and commitment that informs how we serve our members, engage in local communities, and deliver positive change to the health care industry. As health care needs evolve, we leverage our portfolio of companies to deliver differentiated value to all industry stakeholders so that, together, we make more possible.