Quality Assurance Associate II

Note: Applicants must be authorized to work for any employer in the U.S. We are unable to sponsor or take over sponsorship of an Employment Visa currently.

Continental General Insurance Company - Austin, TX 78717

Looking to join a growing company dedicated to helping others? We offer that, plus competitive salaries, great culture, and a relaxed environment. This position allows for a fully remote or hybrid work environment which consists of 2 days per week in the office and 3 days per week remote, if desired. Join our team to help make a difference in the lives of others.

About Continental General

The Continental Insurance family of companies has provided Long Term Care Insurance to individuals and groups for over 30 years and currently provides Long Term Care coverage to approximately 55,000 lives. Continental Insurance, Inc. is primarily focused on managing the Long Term Care Insurance portfolio of its insurance company subsidiaries and pursuing opportunities to expand its Long Term Care Insurance portfolio through acquisitions and strategic partnerships.

The Position:

Supports the Claims Department through regular claim reviews for quality, consistency, and compliance:

• Evaluates performance through pre and post decision file reviews and re-reviews.

• Evaluates the acuity of individual producers using defined criteria and provided tool(s).

• Uses knowledge of the LTC Claim Lifecycle and Regulations to evaluate the handling of LTC Claims across multiple clients.

• Working knowledge of written SOPs for managing and maintaining LTC claims across multiple clients.

• Understands and has strong skills in identifying risk and reducing exposure.

• Acts as a SME, advising on Policy interpretation and regulation guidance, or ascertaining guidance from Compliance and/or Internal/External Legal.

• Compiles quality data and regularly performs training needs analysis, process improvement needs, gaps, and other risk exposure.

• Works closely with Senior QA members and Training Unit to inform on individual and departmental training needs and facilitates monitoring of accuracy and consistency post training/implementation.

• Assists in gathering quality metric data for Senior QA and QA Manager.

• Provide input on potential referrals for the Special Investigation Unit (SIU).

• May assist in the review of and/or responses to complex claims, complaints, regulatory inquires, and litigated matters.

• Assists with testing as needed.

• Assists with input on SOPs as needed.

• Other duties as assigned.

Supports Business Objectives with External Claim Audit and Consulting Engagements:

• Uses knowledge of the LTC Claim Lifecycle and Regulations to evaluate the handling of LTC Claims for external clients.

• Acts as a SME, advising on Policy interpretation and regulation guidance, or ascertaining guidance from Compliance and/or Internal/External Legal.

• Assists in identifying risk exposure and gaps through file reviews.

• Uses defined criteria and provided tool(s) for completing file reviews.

JOB PROFILE

Bachelor's Degree or equivalent experience

3 -5 years of related experience
Possesses demonstrated technical knowledge and skills, including product and industry knowledge, reflective of successful progression through various job family levels.
Performs work under general supervision.