STATE OF CONNECTICUT EXECUTIVE BRANCH JOBS

Quality Control Reviewer

Recruitment #210727-6500VR-003

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Introduction


ABOUT THE AUTHORITY
The State of Connecticut Paid Family and Medical Leave Insurance Authority (the "Authority") is a quasi-governmental agency formed by statute and signed into law by Governor Ned Lamont in 2019. Its mission is to help Connecticut’s workforce navigate health challenges and life changes with greater financial security. 

Through a trust funded by employees, the Authority makes benefits payments to eligible employees when either the employee or their family member takes a leave from work to care for themselves or a family member. 

The Role
The Authority is looking for a Quality Control Reviewer.  The individual(s) selected for this role will report to a Quality Review and Compliance Specialist under the direction of the Business Systems Manager.  The individual selected for this position will primarily be responsible for the review of completed CTPL claims to ensure compliance with CTPL statute and Authority policies procedures.  The individual will also provide support to the Authority’s third-party administrator (TPA) for claims administration.

Position Details:
Hours: 40 hours per week; Monday-Friday
Location: Hartford, Connecticut

Selection Plan

All applicants must include a resume within the "Resume Tab" of their application. 

The immediate vacancy is listed above, however, applications to this recruitment may be used for future vacancies in this job class.

The minimum experience and training requirements must be met by the close date on the job opening, unless otherwise specified.

This posting may require completion of additional referral questions (RQs) which will be sent to you via email after the closing date. The email notification will include an expiration date by which you must submit (Finish) your responses. Please regularly check your email for notifications. Please check your SPAM and/or Junk folders, as emails could end up there in error. 

Note:  At any point during the recruitment process, applicants may be required to submit additional documentation which support their qualification(s) for this position.  These documents may include:  a cover letter, performance reviews, attendance records, supervisory references, college transcripts, licensure, etc., at the discretion of the hiring agency.   

Should you have questions pertaining to this recruitment, please contact Raisa Capellan at raisa.capellan@ct.gov. 

EXAMPLES OF DUTIES

  • As a member of the CTPL Benefits team, work under the supervision of the Quality Review and Compliance Specialist and other employees of higher grade.  
  • Reviews claims pursuant to Authority’s established protocols for eligibility, payment, documentation, and other assigned criteria.
  • Reviews Authority Third Party Administrator’s (TPA) case referrals for guidance and/or accuracy.
  • Identifies findings and discusses results with Business Systems Manager and the Business Process Lead.  In case of issues relating to payments, required documentation or improper eligibility determinations and advises on possible issues and solutions.
  • Reviews decisions of the CT Department of Labor (DOL) Appeals division and ensures correct execution within the Authority as well as the TPA.
  • Works on special reviews and projects as assigned.
  • Attends agency meetings as required.
This list of duties is not intended to be all-inclusive and may be expanded to include other duties and responsibilities that the Authority may deem necessary from time to time and as the Authority’s work and responsibilities demand.

PREFERRED QUALIFICATIONS

Education & Experience Required:
  • Bachelor’s Degree.
  • 2+ years of customer service experience.
Preferred Qualifications
  • Experience in a benefits or insurance claims environment.
  • Experience working with Salesforce or another Customer Relationship Management (CRM) platform.
  • Experience working within a diverse environment with a diverse customer base.
  • Experience with Microsoft Office Suite. 
  • Experience with verbal and written and written communication skills to internal and external stakeholders. 
  • Knowledge of customer service principles.
Additional Skills
  • Technical experience and proficiency on working with and interpreting files and interfaces for claims related systems. 
  • Customer focused background with emphasis on claims administration.
  • Experience collaborating and communicating with teams to improve processes and align with agency goals.
  • Experience handling multiple priorities for a agency or business.
  • Experience identifying and implementing effective creative solutions.

Conclusion

AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER

The State of Connecticut is an equal opportunity/affirmative action employer and strongly encourages the applications of women, minorities, and persons with disabilities.





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