- Evaluates the quality of the physician's report and determines if the report will meet all client and jurisdictional standards.
- Ensures that the claims support the physician's determinations.
- Read & apply policy guidelines, healthcare terminology and delineate when criteria is/is not met.
- Provides strong customer service skills and works closely with clients on a case-by-case basis to provide complete, timely and error free quality assurance of cases.
- Provides oversight to cases that are complex and need additional review prior to return to the client.
- Serves as an additional level of QA and clinical claims knowledge/review for cases with quality Issues.
- Other duties & special projects, as assigned and based on business needs.
- An Associate's Degree or Bachelor's Degree is preferred.
- RN preferred.
- 5+ years of claims experience, preferred.
- Long Term Disability experience required.
- Business experience in a healthcare and/or insurance setting is preferred.
- Must work with a sense of urgency and meet deadlines.
- Must be self-motivated, with a strong drive for performance excellence.
- Excellent written and verbal communication skills are required.
- Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus).
- Attention to detail REQUIRED.
- Present exceptional communication skills with a clear understanding of company business lines. The ability to apply critical thinking, manage time efficiently and meet specific deadlines. Computer literacy and typing skills are essential.
- Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.
- Supply and support their own internet services.
- Maintaining an uninterrupted internet connection is a requirement of all work from home position.
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Disability Claims QA - Royal Palm Beach, United States - Dane Street, LLC
Description
Job Description
Job DescriptionDane Street is looking for highly motivated candidates to join our team as a Disability Claims QA. Dane Street offers an exciting work environment, competitive compensation and a strong growth potential.
As a Disability Claims QA, you will apply your claims knowledge to review reports accompanying medical records to ensure that the report is complete. You will communicate with physician reviewers and their office teams to ensure clarity of information and to ensure all questions posed have been addressed, and to ensure that reports are returned within client deadlines.
Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.
MAJOR DUTIES & RESPONSIBILITIES
Requirements
EDUCATION/CREDENTIALS:
JOB RELEVANT EXPERIENCE:
JOB RELATED SKILLS/COMPETENCIES:
WORKING CONDITIONS/PHYSICAL DEMANDS:
WORK FROM HOME TECHNICAL REQUIREMENTS:
This job description is subject to change at any time.
Benefits
Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. We offer a range of benefits including medical, dental, and vision coverage for you and your family. Additionally, we offer voluntary life insurance options for you, your spouse, and your children. We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.
ABOUT DANE STREET:
A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.
