Full-Time

Quality Audit Analyst

Dgd

Confirmed live in the last 24 hours

HCSC

HCSC

Health insurance provider in multiple states

Financial Services
Healthcare

Compensation Overview

$39.9k - $88.8kAnnually

Junior, Mid

Lombard, IL, USA + 3 more

More locations: Amarillo, TX, USA | Portland, ME, USA | Swansea, IL, USA

Hybrid role requiring 3 days in office and 2 days from home.

Category
Auditing
Accounting
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.
  • 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.
Responsibilities
  • 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.

HCSC provides health insurance services across five states: Illinois, Montana, New Mexico, Oklahoma, and Texas. The company offers a variety of health insurance plans designed for individuals, families, and businesses, ensuring that different healthcare needs are met. HCSC's plans work by collecting premiums from members, which fund the healthcare services they provide. In addition to insurance, HCSC invests in health and wellness programs aimed at lowering healthcare costs and enhancing the health outcomes of its members. What sets HCSC apart from other health insurance providers is its long-standing experience in the industry and its commitment to compassion and innovation in healthcare. The company's goal is to empower people to lead healthier lives while maintaining a focus on quality care.

Company Stage

N/A

Total Funding

$472.7M

Headquarters

Chicago, Illinois

Founded

N/A

Simplify Jobs

Simplify's Take

What believers are saying

  • The new Houston office will create numerous job opportunities, fostering local economic growth and community development.
  • The acquisition of Cigna's Medicare businesses will expand HCSC's product offerings and geographic reach, benefiting current and future members.
  • Recognition as one of the 'Best Places to Work in IT' and having a CEO listed among the 'Most Influential People in Healthcare' highlight HCSC's strong leadership and positive work environment.

What critics are saying

  • The $231,900 fine from the Illinois Department of Insurance for an inaccurate provider directory could damage HCSC's reputation and trust with members.
  • The integration of Cigna's Medicare businesses may pose operational challenges and potential disruptions.

What makes HCSC unique

  • HCSC's strategic expansion into local communities, such as the new Houston office, emphasizes its commitment to economic growth and local workforce development, setting it apart from competitors.
  • The acquisition of Cigna's Medicare businesses significantly enhances HCSC's capabilities and reach in the growing Medicare market, providing a competitive edge.
  • HCSC's collaboration with Feeding America to address root causes of hunger showcases its holistic approach to community health, beyond traditional healthcare services.

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