Global Quality Assurance Specialist

International Medical Group•Indianapolis, IN

4d•Hybrid

About The Position

As one of the world's top International Medical Insurance companies, IMG helps individuals and companies of all sizes. Every second of every day, vacationers, those working or living abroad for short or extended periods, people traveling frequently between countries, and those who maintain multiple countries of residence use our products to give themselves global peace of mind®. We are looking to grow our teams with people who share our energy and enthusiasm for creating the best experience for travelers. The Global Quality Assurance Specialist will be a key member of the Global Quality & Process Improvement Team and will work closely with the Global Quality leadership to ensure the highest level of complaint, escalation and appeal handling and quality assurance in line with any client or regulatory requirements. The Quality Assurance Specialist will play a crucial role in ensuring that customer complaints, appeals or escalations received are handled promptly, accurately and efficiently, as well as support any quality & process improvement initiatives within the enterprise. They will also have day to day responsibility for managing complex, escalated complaints and regulated complaints, escalating to the Global Quality Leadership team appropriately as required. The Global Quality Team services insurance customers by determining insurance coverage and benefits as part of appeal reviews; investigating, examining and resolving medical/dental/life/trip cancellation claim appeals; reviews and responds to appeals on previously adjudicated claims; documenting their actions; maintaining their workload independently; maintaining quality audit standards and ensuring their outcomes are in compliance with the Certificate of Insurance, Policy and Plan Documents as well as legal and regulatory agencies. The Quality Assurance Specialist will also be required to interact with insured members, medical providers, underwriters, brokers/producers, regulators and other third parties by phone and email whilst ensuring outcomes are compliant with policy terms and conditions and are handled within regulatory requirements.

Requirements

Minimum 3 year's experience in claims handling, claim audit, customer service or complaints handling role
Minimum of 5 years’ experience in an insurance or regulated environment
Excellent communication skills, with the ability to effectively interact with customers, team members, and senior management
Attention to detail and good listening skills. Can follow complex instructions
Good interpersonal and customer service skills (both written and spoken)
Enthusiastic, self-motivated with a ‘can do’ attitude
A sound working knowledge of Microsoft Word, Outlook and Excel is a requirement.
The ability to work under pressure as part of a close-knit team
Excellent organizational skills, including the ability to prioritize workload and use own initiative.

Nice To Haves

Previous complaints handling experience in a regulated environment.
Previous Appeals handling experience and knowledge advantageous but not critical as training can be provided
Assistance Case review experience is advantageous
Quality auditing experience preferred – claims, case or call handling audit
Minimum (3) years of experience in Claims Examining
Previous experience and/or proven working knowledge of performing claims adjustments
Command of ICD-9 and ICD-10 or general claim coding practice
Analytical mindset with the ability to interpret data, identify trends, and make data-driven decisions
Knowledge of regulatory requirements related to complaints handling, such as GDPR or HIPAA

Responsibilities

Assist the Quality Team Leader with complaint handling across all business regulated by FCA/ICB/DOI regulations.
Review all complaints in line with FCA/ICB/DOI regulations, to establish the cause of the complaint, ensuring all are acknowledged, logged, and managed through to resolution
Complete and register all Financial Ombudsman Service (or any other regulatory body) file requests
Communicate with underwriters, customers, regulatory bodies internal teams regarding ongoing complaints and ensure all relevant parties are kept updated throughout.
Review appeals and manage to resolution
Ability to leverage technology & customer feedback to improve customer journey
Full awareness of TCF & Consumer Duty requirements, including recognition of Vulnerable Customers and adapt to their needs
Communicate any service delivery issues, training needs, complaints (actual or likely), to department Managers
To carry out any other tasks for which adequate training has been provided, at short notice, as agreed with line manager or other members of the management team.
Share feedback and recommendations with relevant managers on process and training