Senior Insurance Operations Quality Assurance Specialist

🕒 Yesterday

🇺🇸 United States – Remote

💵 $57.5k - $71.9k / year

⏰ Full Time

🟠 Senior

🔧 QA Engineer (Quality Assurance)

🦅 H1B Visa Sponsor

This company has sponsored H1B visas in the past.

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Horace Mann

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1945

🛡️ Insurance

💸 Finance

📚 Education

Insurance • Finance • Education

Horace Mann is a company that provides comprehensive insurance and financial solutions tailored for educators and public sector workers. The company offers a wide range of insurance options including auto, home, renters, liability, life, and supplemental insurance. In addition to insurance, Horace Mann provides retirement and financial strategies, such as 529 College Savings Plans, investment management, and student loan solutions designed specifically to help educators. They are committed to supporting educators through various programs, workshops, webinars, and partnership initiatives that aid in professional and personal financial wellness. Horace Mann is recognized for its strong financial stability and ethical governance practices, ensuring security and privacy for its nearly one million educator clients across the nation.

📋 Description

• Conduct a designated number of daily quality audits for assigned departments. • Evaluate work for accuracy, completeness, and compliance with company policies, procedures, and applicable regulatory requirements. • Perform audits across Claims, Customer Service, New Business, Underwriting, and Policy Services. • Conduct ad hoc and special audits. • Document audit findings and results in Quality Audit databases. • Audit complex, high-risk, and non-routine Supplemental Health claims. • Interpret and apply policy provisions, benefit requirements, limitations, exclusions, and plan language. • Assess claim handling from initial review through final disposition. • Analyze information, identify inconsistencies or missing documentation, and assess whether claim decisions are supported. • Identify processing errors, recurring trends, root causes, and operational improvement opportunities. • Provide feedback to leadership and partner with operational leaders on corrective actions and process improvements. • Assist with development, implementation, and refinement of Quality Audit programs. • Support audit procedures for new products, systems, and services. • Align audit procedures with business processes, policies, industry standards, and regulatory requirements. • Assist the Audit Manager with training, coaching, calibration exercises, and technical guidance.

🎯 Requirements

• High School Diploma or GED. • 3+ years of health claims experience. • Strong understanding of claims processing workflows and Supplemental Health claim administration. • Ability to interpret policy provisions, benefit requirements, limitations, and exclusions. • Exceptional attention to detail and strong analytical and critical-thinking skills. • Ability to evaluate complex information and exercise sound judgment. • Strong written and verbal communication skills. • Previous Quality Audit or Quality Assurance experience (preferred). • Experience auditing complex Supplemental Health claims (preferred). • Experience providing technical guidance, training, or calibration support (preferred). • Advanced claims analysis. • Quality assurance and auditing. • Policy and benefit interpretation. • Root-cause analysis. • Regulatory and procedural compliance. • Data and trend analysis. • Coaching and knowledge sharing. • Operational excellence and continuous improvement.

🏖️ Benefits

• Bonus eligibility • Special rates and benefits for educators (company offering)