Quality Assurance Specialist, Clinical RN – Disability

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September 13

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Dane Street

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Healthcare Insurance • Compliance • Government

Dane Street is a national leader in Independent Medical Exams and Reviews, providing objective, compliant, and timely Independent Medical Examinations, Peer Reviews, and other medical reports. With a large network of over 16,000 physicians, the company offers its services across 25,000 locations and 100 specialties, including Workers' Compensation, Auto, Liability, and Disability claims. Dane Street supports Insurance Carriers, Third Party Administrators, Managed Care Organizations, and Federal/State entities with expert medical analyses, helping them make accurate determinations. The company is recognized for its quality, fast turnaround times, and efficient processes, earning accolades like the NCQA Accreditation in Utilization Management and the Great Place to Work certification.

51 - 200 employees

⚕️ Healthcare Insurance

📋 Compliance

🏛️ Government

📋 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