Disability Claims QA

🕒 Maio 27

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Dane Street

SiteLinkedInTodas as Vagas

51 - 200 funcionários

⚕️ Seguro de Saúde

📋 Conformidade

🏛️ Governo

Healthcare Insurance • Compliance • Government

A Dane Street é líder nacional em Exames e Revisões Médicas Independentes, fornecendo Exames Médicos Independentes (IMEs), Revisões por Pares e outros laudos médicos de forma objetiva, em conformidade e dentro dos prazos. Com uma ampla rede de mais de 16. 000 médicos, a empresa oferece serviços em 25. 000 localidades e 100 especialidades, incluindo sinistros de compensação trabalhista (Workers’ Compensation), automóvel, responsabilidade civil (Liability) e incapacidade (Disability). A Dane Street atende seguradoras, Third-Party Administrators (TPAs), organizações de Managed Care e órgãos federais/estaduais com análises médicas especializadas, ajudando-os a tomar decisões precisas. A empresa é reconhecida pela qualidade, prazos de entrega ágeis e processos eficientes, tendo conquistado credenciais como a Acreditação da NCQA em Utilization Management e a certificação Great Place to Work.

Descrição

• 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 issues, utilizing clinical claims knowledge specific to long-term disability • Participate in other duties and special projects, as assigned, based on business needs

🎯 Requisitos

• 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 • The ability to apply critical thinking, manage time efficiently and meet specific deadlines • Computer literacy and typing skills are essential

🏖️ Benefícios

• medical, dental, and vision coverage for you and your family • voluntary life insurance options for you, your spouse, and your children • other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans • basic life insurance, short-term disability, and long-term disability coverage at no cost • generous paid time off policy • 401k plan with a company match • Apple equipment and a media stipend for remote workspace