Manager, Quality & Compliance

Job Posting End Date: August 26

When you join the team at Unum, you become part of an organization committed to helping you thrive.

Here, we work to provide the employee benefits and service solutions that enable employees at our client companies to thrive throughout life's moments. And this starts with ensuring that every one of our team members enjoys opportunities to succeed both professionally and personally. To enable this, we provide:

• Award-winning culture
• Inclusion and diversity as a priority
• Performance Based Incentive Plans
• Competitive benefits package that includes: Health, Vision, Dental, Short & Long-Term Disability
• Generous PTO (including paid time to volunteer!)
• Up to 9.5% 401(k) employer contribution
• Mental health support
• Career advancement opportunities
• Student loan repayment options
• Tuition reimbursement
• Flexible work environments

*All the benefits listed above are subject to the terms of their individual Plans.

And that's just the beginning...

With 10,000 employees helping more than 39 million people worldwide, every role at Unum is meaningful and impacts the lives of our customers. Whether you're directly supporting a growing family, or developing online tools to help navigate a difficult loss, customers are counting on the combined talents of our entire team. Help us help others, and join Team Unum today!

General Summary:

This position is accountable for supervising the quality assurance and compliance functions of the Provider Relations Department as well as support for mid-market and large case client acquisition. This individual will manage a small team and work to identify process improvement opportunities and coordinate new policies with other members of Provider Relations Management. The individual will also manage the team responsible for developing and driving a balanced and professional response for prospective customers, as well as the management of RFPs / RFIs relative to dental and vision case acquisition - accomplished through coordination and partnering with other functional areas.

This role requires a strong understanding of the dental and vision industry, sales and distribution process, company structure, and software applications used by the mid-market and large case client acquisition team, Provider Relations Department and Claims Department.

Principal Duties and Responsibilities

• Interpret, implement and routinely evaluate Quality Assurance activities.
• Monitor internal processes of Provider Relations department for regulatory compliance, including credentialing, contracting, quality assurance, and directory regulations.
• Devise sampling procedures and directions for recording and reporting quality data.
• Report QA activities to governing bodies as required.
• Review provider data files and loads for accuracy and timeliness.
• Collaborate with Information Technology to ensure proper provider set-up in databases.
• Evaluate internal processes and applications for claims payment accuracy.
• Provide expertise and guidance in interpreting governmental regulations, other industry standards (e.g. NCQA), and internal policies to assure compliance and effectiveness.
• Maintain proficiency in software and other tools in the department
• Analyze new legislation and regulations and, working with business units, determine their impact on the company's business
• Assist with collection of information, reporting, and recommending solutions. Communicate policies, procedures and other requirements relating to compliance with regulations and department policy
• Document actions to comply with legislative, regulatory and audit requirements, creating a record to support ongoing compliance monitoring
• Assist department with data management and work planning
• Communicate and interact effectively and professionally with co-workers, management, customers, etc.
• Maintain complete confidentiality of company business
• Maintain communication with management regarding development within areas of assigned responsibilities and perform special projects as required or requested
• Support and manage the team with the production of high-quality proposal / RFP questionnaire responses in support of the new business acquisition/ sales goals.
• Perform other duties as assigned.

Job Specifications

• Minimum 5-7 years related experience, preferably in Provider Relations or Compliance
• 4 year college degree preferred. Significant experience considered in lieu of degree.
• Strong understanding of compliance requirements and regulations within the healthcare industry, strongly preferred.
• Strong verbal communication skills
• Excellent customer service philosophy
• Ability to lead and motivate others
• Critical thinking and problem-solving abilities
• Intermediate to advanced Excel skills strongly preferred

#LI-JQ1

~IN1

Unum and Colonial Life are part of Unum Group, a Fortune 500 company and leading provider of employee benefits to companies worldwide. Headquartered in Chattanooga, TN, with international offices in Ireland, Poland and the UK, Unum also has significant operations in Portland, ME, and Baton Rouge, LA - plus over 35 US field offices. Colonial Life is headquartered in Columbia, SC, with over 40 field offices nationwide.

The base salary range for applicants for this position is listed below. Unless actual salary is indicated above in the job description, actual pay will be based on skill, geographical location and experience.
$75,500.00-$135,900.00

Additionally, Unum offers a portfolio of benefits and rewards that are competitive and comprehensive including healthcare benefits (health, vision, dental), insurance benefits (short & long-term disability), performance-based incentive plans, paid time off, and a 401(k) retirement plan with an employer match up to 5% and an additional 4.5% contribution whether you contribute to the plan or not. All benefits are subject to the terms and conditions of individual Plans.

Company:
Starmount Life

Client-provided location(s): Atlanta, GA

Job ID: Unum_Group-1876167408

Employment Type: FULL_TIME

Posted: 2024-08-06T23:38:43