Disability Clinical RN Quality Assurance Specialist

Overview

The company the company is seeking highly motivated candidates to join our team as a Clinical (RN) QA Specialist, specializing in Disability. We offer an exciting work environment, competitive compensation, and strong growth potential.

Summary

As a Clinical (RN) QA - Disability Specialist, you will leverage your expertise in long-term disability claims to review and ensure to accuracy and completeness of reports accompanying medical records. You will communicate with physician reviewers and their teams to ensure clarity of information, address all posed questions, and meet client deadlines.

Key Responsibilities

• Assess the quality of physician reports, ensuring they meet all client and jurisdictional standards specific to long-term disability claims.

• Verify that the claims support the physicians determinations in long-term disability claims.

• Read and apply policy guidelines and healthcare terminology, determining when criteria for long-term disability are met.

• Provide strong customer service by working closely with clients on a case-by-case basis to deliver complete, timely, and error-free quality assurance for long-term disability cases.

• Manage and provide oversight for complex long-term disability cases requiring additional review prior to returning to the client.

• Serve as an additional level of QA for cases with quality issus, utilizing clinical claims knowledge specific to long-term disability.

• Participate in other duties and special projects, as assigned, based on business needs.

Requirements

EDUCATION/CREDENTIALS

• An Associate’s Degree or Bachelor’s Degree is preferred.

• RN required.

JOB RELEVANT EXPERIENCE

• 5+ years of claims experience, preferred.

• 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.

JOB RELATED SKILLS/COMPETENCIES

• 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.

WORKING CONDITIONS/PHYSICAL DEMANDS

Any lifting, bending, traveling, etc. required to do the job duties listed above.

Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS: Supply and support their own internet services.

Maintaining an uninterrupted internet connection is a requirement of all work from home position.

This job description is subject to change at any time.

Beginning compensation will depend on several factors including the candidate's experience, education, and specific skills. In addition to the base salary, we offer a comprehensive benefits package including health insurance, retirement plans, and performance bonuses.

Our Commitment

We are committed to providing fair and competitive compensation that reflects each employee's contributions and performance. We value diversity and strive to create an inclusive environment for all employees.

Compensation Range: $65,000 - $90,000

Benefits

Join our team at the company the company 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 the company the company

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.