Claims Audit Director

Marsh McLennan Agency's East Region is a leader in the employee benefits marketplace. Our associates simplify employee health and welfare benefits and risk management for regional, national, Fortune 500 and Fortune 1000 companies.

We value integrity, collaboration, passion, innovation, and accountability, and we are committed to making a difference in the moments that matter for our colleagues, clients, and communities.

BRIEF DESCRIPTION

The Leave and Disability Claim Audit Director is a senior leadership role responsible for overseeing the audit function within Marsh McLennan Agency East Region’s Absence, Disability and Life Center of Excellence. This role requires a combination of leadership, analytical, and technical expertise to ensure compliance with relevant laws, identify risks, and enhance the efficiency and effectiveness of leave and disability claim management for MMA East clients.

ESSENTIAL DUTIES AND RESPONSIBILITIES include, but are not limited, to the following:

• Audit Universe and Risk Assessment: Identify and maintain the audit universe, and execute the annual audit calendar for absence, disability, life and voluntary benefit clients.
• Audit Oversight and Execution: Oversee scoping decisions, audit opinions, issue identification, severity assessment, and remediation tracking. Manage auditors to ensure consistent quality and adherence to internal audit methodology.
• Compliance and Regulatory Adherence: Ensure compliance with federal, state, and local laws such as FMLA, ADA, PDA, PWFA, USERRA, and other relevant leave laws. Stay current with trends and legislation related to disability claims management and accommodations.
• Process Review: Conduct comprehensive reviews and gap analyses of leave and other benefit processes to ensure compliance.
• Client and Stakeholder Interaction: Maintain relationships with management-level leaders and business partners, both internally and externally.
• Reporting and Analysis: Provide reports and analysis of trends, including gap analysis within disability management programs (Leaves/STD/LTD/Accommodation/WC) as well as other benefits.
• Leadership and Mentoring: Provide high-level direction, develop long-range goals and objectives, and coach and mentor audit staff.
• Issue Resolution: Identify and lead resolution of service issues or contract misalignments.

REQUIRED EDUCATION AND EXPERIENCE :

• Bachelor’s Degree or equivalent experience preferred
• 3-5 years of progressive experience managing quality assurance and/or audit functions.
• 7-10 years of relevant leave and disability industry experience with leadership experience preferred.
• Certifications such as Certified Employee Benefit Specialist (CEBS), National Institute of Disability Management and Research (NIDMAR), or Certified Internal Auditor (CIA) preferred, but not required.
• Advanced degrees in Rehabilitation Counseling, Social Work, Psychology, or related fields preferred, but not required.

KNOWLEDGE, SKILLS AND ABILITIES

• Strong analytical, problem-solving, and decision-making skills.
• Excellent communication, presentation, and interpersonal skills.
• In-depth knowledge of federal, state, and local leave and disability laws.
• Proficiency in Microsoft Office, HR Information Systems, and Case Management systems.
• Proven leadership and management capabilities with the ability to inspire and motivate teams.
• High organizational awareness and ability to partner effectively across all levels.
• Ability to maintain strict confidentiality.
• Strong project management skills.
• Knowledge of internal audit standards and methodologies.
• Strong organizational, management and account planning skills with analytical skills and strong attention to detail
• Work in a high production team environment with a high degree of complexity
• Operate independently and provide appropriate information and direction to other individuals
• Provide effective, accurate, clear communication to internal company team members and clients
• Ability to interact in a professional manner with clients, vendors, carriers and internal departments including sales, marketing, HR, Finance, IT and other functional areas within MMA East and designated key accounts
• Ability to interact with and focus on information gathering and collaborative solution development in a proactive manner
• Ability to handle sensitive and confidential information
• Ability to lead team development and motivate others
• Project management capability
• Excellent troubleshooting, decision making and problem-solving skills
• Ability to work well independently and as a team member; multitask and successfully operate in a fast-paced work environment; prioritize projects and meet deadlines
• Ability to follow through on and successfully execute tasks while adhering to specified quality standards
• Proficiency in use of PC such as keyboard skills and electronic folder/file organization and management
• Aptitude for learning internal systems, applications and internal workflow of the department
• Must be able to effectively interact and deal with people at all levels inside and outside of the company

PHYSICAL DEMANDS AND WORK ENVIRONMENT

• The physical demands described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
• While performing the duties of this job, the employee is:
  • Frequently required to sit; speak or hear; use hands to finger, handle, feel objects, and reach with hands and arms;
  • Occasionally required to stand and walk;
  • Extensive use of computer and keyboard and viewing of computer screen is required;
  • Specific vision abilities required by this job include vision, and ability to adjust focus.
• Other working conditions are normal for an office environment.

WORK LOCATION

• Work is typically performed either remotely or in a hybrid manner at MMA East’s Conshohocken, PA office, or at various customer/MMA locations as required.

The applicable base salary range for this role is $90,000 to $120,000.
The base pay offered will be determined on factors such as experience, skills, training, location, certifications, and education. Decisions will be determined on a case-by-case basis. In addition to the base salary, this position may be eligible for performance-based incentives.

We are excited to offer a competitive total rewards package which includes health and welfare benefits, tuition assistance, 401K savings and other retirement programs as well as employee assistance programs.

Marsh McLennan is committed to embracing a diverse, inclusive and flexible work environment. We aim to attract and retain the best people and embrace diversity of age background, disability, ethnic origin, gender orientation or expression, marital status, nationality, parental status, personal or social status, political affiliation, race, religion and beliefs, sex/gender, sexual orientation or expression, skin color, veteran status (including protected veterans), or any other characteristic protected by applicable law. If you have a need that requires accommodation, please let us know by contacting [email protected]

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