Disability Clinical RN Quality Assurance Specialist
D
Dane StreetInsurance Healthcare
United StatesFull-TimeMiddle
Salary$65,000 - $90,000
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Job Details
- Experience
- 5+ years of claims experience, preferred.
- Required Skills
- Quality AssuranceCritical thinking
Requirements
- Registered Nurse (RN) license required.
- Associate’s Degree or Bachelor’s Degree preferred.
- 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.
- Proficiency in navigating a variety of computer programs.
- Attention to detail required.
- Ability to apply critical thinking and manage time efficiently.
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.
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