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Maine.gov > PFR Home > Insurance Regulation > UNUMProvident Multistate Examination/Settlement Agreement

Exhibit 3


Position Title: Quality Compliance Consultant
Job Code: New role to organization
Job Level:
Exemption Status: Exempt

General Summary

This highest level technical position is directly responsible for ensuring quality (appropriate file documentation and decision rationale) and compliance. They are relied upon to provide guidance, training and direction to the Disability Benefits team with a strong partnership with Legal.

Principal Duties and Responsibilities

Claim Management

  • Enhance organizational performance through ensuring quality of claim documentation and decision rationale
  • Develop and build in-depth technical expertise in the Disability Benefits team
  • Analyze and conduct needs assessment to assist with development of strategies to improve quality of performance
  • Utilize and convey expertise in multiple product lines (STD, LTD, IDI)
  • Mentor claims personnel
  • Utilize appropriate resources, as needed, to arrive at thorough, fair and objective decisions
  • Proactively review files to assess quality and compliance
  • Ensure corporate and claimant compliance with ERISA standards, as applicable

Customer Service and Partnering

  • Provide feedback to Disability Benefits Specialists, Managers, and Directors on quality of specific claim documentation and decision rationale
  • Build and maintain partnerships with management team members and legal team
  • Partner with Legal to provide quantitative and qualitative feedback on overall quality of claim documentation and decision rationale
  • Partner with QPS (Appeals, Audit and Training) to identify trends and develop action plans to improve overall quality of claim management
  • May perform other duties as assigned

Job Specifications

  • Any combination of education or experience equivalent to ten years disability experience and/or seven years disability claims experience preferred
  • Demonstrated success in managing highly complex claims
  • Undergraduate degree required
  • Strong preference for one or more Insurance Industry designations (ALHC, FLMI, ACS, etc.)
  • Proven ability to successfully coach and mentor others
  • Strong decision making and problem solving skills
  • Ability to effectively and professionally interact/partner with internal and external representatives and resources
  • Exceptional written and oral communications
  • Superior analytical skills with an understanding of the functional requirements of the organization
  • Demonstrated understanding of disability claim operations

 

Last Updated: August 22, 2012