Global Quality Assurance Specialist

International Medical Group • Indianapolis, IN

1d • 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 years of experience in a regulated insurance environment, preferably in a claims handling, complaints handling and/or customer service role.
• Excellent communication skills, with the ability to effectively interact with customers, team members, and senior management
• Analytical mindset with the ability to interpret data, identify trends, and make data-driven decisions.
• 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

• Minimum 1 year experience in a complaints handling experience in a regulated environment.
• Previous experience and knowledge of handling appeals, complex case or claim reviews and or quality auditing would be advantageous but not critical as training can be provided
• Previous experience and/or proven working knowledge of performing claims adjustments
• Command of medical coding, such as ICD-10 and CPT
• Knowledge of regulatory requirements related to complaints handling, such as GDPR or HIPAA, is preferred, with awareness of Treating Customer Failry & Consumer Duty requirements, including recognition of Vulnerable Customers and adapting to their needs

Responsibilities

• Effectively and accurately managing complaints across all areas of the business including those regulated by FCA/ICB/DOI.
• 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 and 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
• Complete quality checks and audits, and report results to department management where required
• Communicate any service delivery issues, training needs, complaints (actual or likely), to he Global Quality Team Leader
• Collaborate to work with Operations and claims management to improve quality and performance through case reviews
• Assist the Global Quality Leadership team to identify and evaluate business processes and customer journeys, helping to develop and implement quality and compliance metrics and identifying opportunities to improve the quality of the service provided.
• 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

Benefits

• Comprehensive benefits package including Medical / RX / Dental / Vision / Life insurance
• 401k Plan with company match
• Paid Time Off and Company Paid Holidays
• Free employee parking
• On site fitness center
• Casual dress environment
• Tuition reimbursement plan

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: No Education Listed