Regulatory Coordinator

National General Insurance

(Milwaukee, Wisconsin)
Full Time
Job Posting Details
About National General Insurance
You're appreciated for the diversity of ideas and unique skills you bring to National General Insurance because they are essential to our success. Hard work and dedication are among your greatest strengths and it shows. Working here means you have the opportunity to be part of an empowering professional environment where all team members are valued for their unique talents and contributions.
Responsibilities
* Document and manage appeals, grievances, and escalated issues from receipt through completion. * File related documents of appeals and grievances in network folders for reference. * Grievance/Appeals * Review grievance/appeal packet sent from third party administrators for completeness. Log them. * Determine at a high level if there is an appeal/grievance; Confer with legal as needed. * Discuss issues with staff nurse as needed. * Secondary review with staff nurse and Legal if necessary. * Complete grievance packets for panel review. * Conduct panel meetings for decision of grievances.Document outcome and mail appeal letter decisions. * Rescissions * Gather appropriate misrepresentation documents needed for rescission.Log them. * Complete rescission template for panel review. * Hold panel meeting for decision of rescission. * Notify outcome of intent to recession decision. * Manage outside medical review if needed. * Escalated issues (DOI complaints, Agent Complaints, Fraud issues) * Document issue and log - manage from receipt through resolution. * Obtain required information. * Compile info in appropriate document format for review by appropriate area (Legal, Product, Medical review). * Work with legal/compliance and other stakeholders as needed. * Department of Insurance and Federal survey/data responses * Work with various stakeholders to submit timely state survey/data responses. * Approximately 250 reports annually.
Ideal Candidate
* Project management skills a plus. * Attention to detail is a must. * Work well with minimal oversight. * Insurance/regulatory background required. * Health Insurance in particular is a plus.
Compensation and Working Conditions
Benefits Benefits included

Additional Notes on Compensation

Paid Training Medical, Dental, Vision benefits Wellness Programs Life and Short/Long Term Disability Insurance 401k w/ company match Company Paid Holidays Generous Time-off policy On-site Healthcare Clinic (Winston-Salem and Clevelan

Questions

Answered by on
This question has not been answered
Answered by on

There are no answered questions, sign up or login to ask a question

Want to see jobs that are matched to you?

DreamHire recommends you jobs that fit your
skills, experiences, career goals, and more.