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Claims Compliance Coord II

AFLAC locationColumbus, GA
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49 positions
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49 positions
info linkReport a probelm Originally Posted : October 09, 2021 | Expires : November 8, 2021

Details

Salary
Unspecified
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Job Location
Columbus, GA, United States

Description

Job Summary

Conducts proactive market conduct reviews and process audits to ensure compliance with state and federal laws and regulations; works with management to determine the regulatory impact to Aflac's policies and services related to claims processing; reviews and responds to Department of Insurance filings; monitors implementation and revises for effectiveness; conducts continuous improvement audits to ensure that corrective actions are followed

Principal Duties & Responsibilities

Works closely with Compliance, Legal, Internal Audit, and various other departments to assist in analyzing state and federal insurance requirements as it relates to claims processes; researches and compiles information necessary to prepare insurance (DOI) filings

Operates with some limited latitude for independent action or decision-making while recommending sound internal control practices; assists with consistent interpretation and implementation of claims compliance policies and standards across the division; on an ongoing basis, monitors compliance of business units to established regulatory guidelines, procedures, and policies; drives an ongoing awareness and understanding of and monitors adherence to all applicable regulatory requirements, policies, procedures, and compliance processes to ensure that the appropriate control environment is documented and tracked

Conducts proactive market conduct reviews, communication, and facilitation to address non-conformance to laws and regulations; reviews insurance laws and regulations, and works with management to determine the impact to Aflac's policies and services related to claims processing; develops reports for market conduct exams and mitigation activities; reviews accuracy of incoming reports related to claims information

Serves as a liaison between Compliance and Claims; tracks, researches, and responds to Department of Insurance complaints within established time frames; assists in the research and coordination of responses to regulatory inquiries; resolves issues, answers questions, and clarifies interpretations of laws and regulations or potential changes in business practices; forwards more complex initiatives to a more experienced compliance analyst for guidance and/or action

Assists in the evaluation, development and implementation of claims policies and procedures; assesses, analyzes, and improves the effectiveness and efficiency of governance and operational control processes; identifies process risks and ensures compliance with laws and regulations; implements appropriate control, design, and risk mitigation methods; monitors implementation and revises for effectiveness; conducts continuous improvement audits to ensure that corrective actions are followed

Coordinates with departmental teams such as Research and Resolution, Critical, and Fraud to gather, analyze and implement process flow changes related to all claims risk activities; serves as a claims subject matter expert for current and upcoming legislation proposals that may impact Aflac; participates in project review sessions and coordinates with Information Technology regarding any system changes

Reviews, documents, and acts as a point of contact for Aflac Trust on processes involving policyholder claims management at the associate level; provides quarterly closure reporting of death claims; researches and resolves regulatory questions, reporting discrepancies, and interest calculations; assists with completing reports of external audit examinations as necessary; collaborates with Regulatory Compliance to initiate state emergency order procedures and reporting;

Performs other duties as assigned

Education & Experience Required

Bachelors Degree In a related field

2 - 4 years of related work experience working with the establishment of business processes/procedures derived from compliance, regulatory, and/or business policy issues

Or an equivalent combination of education and experience

Job Knowledge & Skills

  • Knowledge of company operations, products, and services

  • Fundamental knowledge of auditing process and quantitative and qualitative risk assessment methodologies

  • Proficiency using Microsoft Office software, including Excel, Word, and PowerPoint

  • Excellent oral, written, and interpersonal communication skills

    Competencies

    Acting with Integrity - Clearly states goals and beliefs; lets people know his/her true intentions; does what he she said they would do; follows through on commitments

    Communicating Effectively - Expresses ideas and information in a clear and concise manner; tailors message to fit the interests and needs of the audience; delivers information in a manner that is interesting and compelling to the listener

    Pursuing Self-Development - Demonstrates ambition and desire to move forward in his/her career; engages others in discussions about career development; seeks feedback on ways to increase his/her performance; takes advantage of opportunities to build new skills and capabilities

    Serving Customers - Builds strong relationships with customers; stays aware of customer needs, concerns and satisfaction; responds promptly to customer questions and requests; effectively manages

    Supporting Change - Enthusiastically participates in new change initiatives and programs; focuses on reasons why changes will work and how they will be beneficial

    Supporting Organizational Goals - Actively supports organizational goals and values; demonstrates enthusiasm toward the companys goals and mission; aligns actions around organizational goals

    Working with Diverse Populations - Shows respect for the beliefs and traditions of others; encourages and promotes practices that support cultural diversity; discourages behaviors or practices that may be perceived as unfair, biased, or critical toward people with certain backgrounds

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