Clinical Auditor - Long Term Disability, RN
Description:
Overview:
Perform and summarize audits for improving overall performance of employees and quality of business.
Work directly with leadership to ensure assigned training is appropriate.
Summary:
Dane Streets 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.
Key Responsibilities:
Conducts scheduled audits as well as ad hoc audits.
Provide summary and recommendations.
Implement corrective actions recommended by clients.
Identifies areas where issues exist and works with appropriate individuals to ensure resolution.
Provide aspects of training to employees in specific assigned departments.
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.
Requirements:
EDUCATION/CREDENTIALS:
An Associates Degree or Bachelors Degree is preferred.
RN required.
JOB RELEVANT EXPERIENCE:
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.
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.
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.
Apply Now
Overview:
Perform and summarize audits for improving overall performance of employees and quality of business.
Work directly with leadership to ensure assigned training is appropriate.
Summary:
Dane Streets 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.
Key Responsibilities:
Conducts scheduled audits as well as ad hoc audits.
Provide summary and recommendations.
Implement corrective actions recommended by clients.
Identifies areas where issues exist and works with appropriate individuals to ensure resolution.
Provide aspects of training to employees in specific assigned departments.
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.
Requirements:
EDUCATION/CREDENTIALS:
An Associates Degree or Bachelors Degree is preferred.
RN required.
JOB RELEVANT EXPERIENCE:
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.
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.
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.
Apply Now