Liability IME Operations Specialist

🕒 Junho 15

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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

• Intake new cases and review/verify information and requests. Draft cases by entering information into the Dane Street system, AccessDS. • Work with the client on any information missing that is pertinent to processing the claim. • Sort, organize, and create a medical document listing if required by the client and in accordance with specific special handling. • Assign/schedule new cases to physicians for review with the appropriate physician based on location, reviewer availability, specific guidelines, jurisdictional requirements, and other client requirements. • Ensure that the assigned physician has no conflict of interest with the case assignment. • Monitor, process, and track cases to ensure we meet deadlines. • Review reports accompanying medical records to ensure that the report is complete and that all questions posed by the client have been addressed. • Follow up with the reviewer with any additional questions or clarification needs. • Update clients frequently on referral progress. • Ensure the report is grammatically correct with no spelling errors. • Ensure each referral adheres to the QA checklist prior to the completion. • Communicate clearly and concisely between the customer, reviewer, and Operations team. • Must confidently speak with physicians and clients regarding the content of their IME/record reviews. • Update clients frequently on cases in progress. • Ensure proper documentation for specified cases is provided to the client.

🎯 Requisitos

• An Associate’s Degree or Bachelor’s Degree is preferred. • Business experience in a healthcare and/or insurance setting is preferred. • Operations experience with technology-based processes within the business environment. • 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

• 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.