Case Coordinator

This is a fully remote position, open to applicants in California.

📋 Description

• Conduct quality assurance evaluations of reports, correspondence, addendums, and supplemental reviews.

• Ensure that recommendations and determinations are supported by clear, concise, evidence-based rationales.

• Confirm that client instructions, specifications, and inquiries are adequately addressed.

• Validate that clinical citations and references are up-to-date and sourced from reputable medical journals or publications.

• Ensure that the content, format, and professional appearance of reports align with company standards.

• Verify that appropriate board specialty reviews and accurate documentation are present in case reports.

• Confirm peer reviewer attestations and ensure there are no conflicts of interest.

• Ensure that provider credentials and signatures are included in the final reports.

• Identify inconsistencies in reports and reach out to Peer Reviewers for clarification or correction.

• Assist in addressing customer complaints and quality assurance issues.

• Ensure adherence to federal ERISA and state mandates.

• Provide management with insights on consultant quality, availability, and compliance.

• Promote the effective use of company resources.

• Engage in educational and training activities.

• Perform other assigned duties.

⛳️ Requirements

• High school diploma or equivalent is required.

• At least two years of clinical or related field experience, or an equivalent combination of education and experience.

• Familiarity with the insurance industry, preferably in claims management related to workers compensation, no-fault, liability, and/or disability.

• Strong understanding of medical terminology, anatomy and physiology, medications, and laboratory values.

• Ability to perform arithmetic calculations with whole numbers and decimals, and compute rates and percentages.

• Qualified typist with a minimum typing speed of 40 W.P.M.

• Proficient in operating a computer, fax machine, copier, scanner, and telephone.

• Knowledgeable in Microsoft Word, Outlook, Excel, and the Internet.

• Excellent command of the English language, including grammar, punctuation, and style.

• Ability to accurately follow instructions and respond effectively to upper management.

• Capable of working independently, prioritizing tasks, and managing time efficiently.

• Ability to maintain confidentiality.

• Ability to remain focused in normal or high-distraction environments.

🏝️ Benefits

• Medical insurance

• Vision insurance

• Dental insurance

• Paid time off

• 401k