Compliance Specialist

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:

We are looking for a result-driven Compliance Specialist. The Compliance Specialist will oversee employees in the Quality Control Reviewer and report to and work closely with the Benefits Process Lead under the direction of the Business Systems Manager. The individual selected for this role will be responsible for planning, reviewing, scheduling claim audit functions to ensure the TPA’s compliance of the Authority’s contract with the TPA, CT statute and Authority Policies. The incumbent may also be assigned to handle complex escalated cases and review of automated reports.

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.

State employees currently holding the above title or those who have previously attained permanent status in this class may apply for a lateral transfer.

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 Jennifer Neumann at jennifer.neumann@ct.gov and reference the recruitment number.

Examples of Duties:

• Reviews and analyzes Paid Family Leave case archives to verify conformance with all pertinent state laws and Authority policies
• Oversees and reviews the work of employees reporting to this role
• Conducts performance evaluations
• Collaborates with internal and external stakeholders on compliance related issues
• Assists with the development and maintenance of a comprehensive audit and compliance process
• Establishes and maintains unit procedures
• Develops or makes recommendations on development of policies and standards
• Prepares reports and correspondence; synthesizes, analyzes and documents quality control data for inclusion in state and federal reports.
• As required, performs interviews, evaluations and/or conferences to conduct audits.
• Identifies audit findings and discusses results with Business Systems Manager. In case of issues relating to payments, needed documentation or improper eligibility determination, advises on possible solutions.
• Excellent relationship building skills, demonstrated success working in teams and on projects, towards a common goal.
• Reviews decisions of the CT Department of Labor (DOL) Appeals division and ensures correct execution within the Authority as well as the TPA.
• Works with the Business Process Lead and the Business Systems Manager to implement corrective action.
• Works on special reviews and other projects as assigned.
• Attends agency meetings as required.

The preferred candidate will have:

• Bachelor’s degree
• Interpersonal skills
• Customer Service Experience
• 5+ years of experience working in a benefit, claims or audit environment
• 2+ years in a lead role
• Experience with Microsoft Office Suite
• Experience using verbal and written communication with internal and external customers
• Organizational and analytical skills

Desired Skills:

• Experience in a benefits or insurance claims environment.
• Experience working with Salesforce, another Customer Relationship Management platform or audit system.
• Experience working within a diverse environment with a diverse customer base.

Other Key Skills:

• Research and analysis skills.
• Experience working with and technical know-how on how to work with and interpret files and interfaces for claims related systems.
• Knowledge of principles and case management.
• Experience synthesizing and analyzing data.
• Experience with audit procedures.
• Experience leveraging interpersonal skills to work cohesively as part of a team to deliver excellent results and maintain a collegial work environment.
• Experience exercising analytical, verbal and written communication skills to vendors, co-workers, management and third parties.
• Demonstrated ability to participate in a complex and fast-moving work environment.
• Attention to detail, and follow-through, while balancing and prioritizing multiple activities and responsibilities.
• Experience exercising relationship-building skills and ability to inspire collaboration, including success in working in teams, project and people towards a common goal.
• Demonstrated experience engaging in creative problem solving and taking initiative, while utilizing a solutions-oriented approach and exhibiting flexibility and good judgement in a complex organizational ecosystem.
• Position may require occasional travel.

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.