Remote New

Quality Analyst - Disability & Leave Benefits Claims

Protective Life Insurance Company
vision insurance, parental leave, paid time off, 401(k)
United States
Jan 31, 2025
The work we do has an impact on millions of lives, and you can be a part of it. We help protect our customers against life's uncertainties. Regardless of where you work within the company, you'll be helping provide protection and peace of mind when our customers need it most. The Quality Analyst is responsible for ensuring the accuracy and integrity of claim information and the actions taken by Claims Examiners. This role involves auditing claims, preparing detailed reports, and making recommendations for quality improvements. The Quality Analyst plays a crucial role in maintaining high standards and consistency within the Claims department, contributing to the overall efficiency and effectiveness of the team. To be successful in this role, the candidate must possess very strong critical thinking, organizational, and time management skills, along with a keen attention to detail due to the personal nature of the payouts involved. This role requires at least 2 years of experience with, and above average knowledge of State-Mandated Disability Leave, short-term and long-term disability, or FMLA leave administration and claims. The ideal candidate will have above-average communication and process auditing skills, a natural curiosity to learn, and the ability to quickly assimilate new information. They should also be comfortable with technology and adaptable to continuous improvements in both technology and work processes. Key Responsibilities Thoroughly understand departmental processes and regulatory provisions and their proper application. Devise sampling methodology and retrieve audit samples from appropriate sources. Objectively review an equal number of claims, via random sample, per examiner per month. Evaluate the overall management of each audited claim, including claimant, employer, and medical information, to determine benefit eligibility, claim duration, and benefits payable. Make determinations if assigned claims were approved, pended, or denied, consistent with department turnaround and accuracy standards. Ensure examiner communication/documentation accurately informs their respective audience of the correct disposition regarding claim status, including payments or denials. Accurately and thoroughly document claim reviews with examiner, claim number, errors, and corrections to be made. Escalate issues and complex claims to Subject Matter Experts and/or Claims Supervisors. Determine, monitor, and analyze measurements, conduct trend analyses, identify liabilities and miscalculations on claims, and prepare illustrative reporting. Review and respond to Quality Audits/Audit Correspondences. Support the Claims Quality Assurance Program in developing and implementing quality improvement strategies. Identify root causes to determine appropriate (re)training needs and suggest enhancements to policies and procedures. Promote a positive customer experience through prompt, accurate, and courteous services to both internal and external customers. Contribute to a positive work environment to ensure the achievement of departmental and corporate goals and objectives. Contribute to various departmental projects and assignments as needed. Occasionally serve in the role of Claim Examiner upon management's request, meeting the production objectives and goals set forth by the department. Skills and Abilities: Thorough knowledge of federal and state laws related to leaves of absence and paid family medical leave. Ability to interpret and administer policy and plan provisions. Proficiency in calculating earnings, benefit levels, and FICA taxes. Skilled in gathering, analyzing, and organizing data to make informed decisions. Capable of identifying critical issues and exercising independent judgment. Proven ability and willingness to provide candid and meaningful feedback. Preferred knowledge of medical terminology. Excellent written and verbal communication, along with strong interpersonal skills. Strong reading, writing, and arithmetic abilities. Proficient in Microsoft Excel and Word. Minimum Requirements High School diploma required College degree or an equivalent of at least three (3) years of work experience preferred. 2-3 years' experience in a disability claims environment. Experience with state mandated disability claims is required. Experience working in Quality Assurance/ Quality Auditing roles is highly preferred. Schedule Details This role operates on a semi-flex 40 hour a week, M-F schedule. Mandatory core hours may be assigned based on business needs. Protective's targeted salary range for this position is $50,000-60,000. Actual salaries may vary depending on factors, including but not limited to, job location, skills, and experience. The range listed is just one component of Protective's total compensation package for employees. #ind123 Employee Benefits: We aim to protect our employees' wellbeing through a broad benefits offering. For example, we protect physical wellbeing through health, dental and vision insurance. We protect mental wellbeing through mental health benefits and an employee assistance program. We protect time away from work with a variety of paid time away benefits ( e.g., paid time off, paid parental leave, short-term disability, and a cultural observance day). We protect financial wellbeing through contributions to healthcare accounts, a pension plan, and a 401(k) plan with Company matching. All employees are encouraged to protect their overall wellbeing by engaging in ProHealth Rewards, Protective's platform to improve wellbeing while earning cash rewards. Eligibility for certain benefits may vary by position in accordance with the terms of the Company's benefit plans. Diversity and Inclusion : At Protective, we are committed to providing an inclusive culture where all employees are able to fully contribute and thrive. Our goal is to grow and develop our people, attract diverse talent and support strong, diverse communities. We support diversity, equity, and inclusion by working to develop a culture of inclusion and belonging led by leaders who develop potential and embrace all skills and abilities. Our aim is to create an equitable environment for all leaders and employees that will drive performance and impact business strategy. In this way, we can increase overall diversity for leadership roles and pipelines of talent by maturing our hiring practices, robust development opportunities and focus on retention of key talent. We are proud to be an equal opportunity employer committed to being inclusive and attracting, retaining, and growing the talents of a diverse and inclusive workforce. Accommodations for Applicants with a Disability : If you require an accommodation to complete the application and recruitment process due to a disability, please email martina.winston@protective.com.This information will be held in confidence and used only to determine an appropriate accommodation for the application and recruitment process. Please note that the above email is solely for individuals with disabilities requesting an accommodation. General employment questions should not be sent through this process.