Job Description:
• Review and ensure accuracy and completeness of reports accompanying medical records for long-term disability claims
• 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 to determine when criteria for long-term disability are met
• Communicate with physician reviewers and their teams to ensure clarity of information and address posed questions
• 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 issues, utilizing clinical claims knowledge specific to long-term disability
• Participate in other duties and special projects, as assigned, based on business needs
• Meet client deadlines and maintain high standards of performance
Requirements:
• RN required
• An Associate’s Degree or Bachelor’s Degree is 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 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
• Ability to apply critical thinking, manage time efficiently and meet specific deadlines
• Computer literacy and typing skills are essential
• Must supply and support own internet service and maintain an uninterrupted internet connection for work-from-home role
Benefits:
• medical, dental, and vision coverage for you and your family
• voluntary life insurance options for you, your spouse, and your children
• voluntary benefits including hospital indemnity, critical illness, accident indemnity, and pet insurance plans
• basic life insurance provided at no cost
• short-term disability coverage provided at no cost
• long-term disability coverage provided at no cost
• generous paid time off
• 401k plan with company match
• performance bonuses
• Apple equipment and a media stipend for remote workspace