Quality Assurance Specialist, Clinical RN – Disability

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 Apply tot his job