Disability Claims QA Specialist

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

📋 Description

• Evaluate the quality of physician reports in accordance with client and jurisdictional standards for long-term disability claims.

• Confirm that claims substantiate physicians’ decisions regarding long-term disability.

• Interpret policy guidelines and healthcare terminology to identify when long-term disability criteria are satisfied.

• Collaborate with clients on an individual basis to ensure complete, timely, and accurate quality assurance.

• Engage with physician reviewers and their teams to clarify details, answer inquiries, and adhere to client timelines.

• Oversee and manage intricate long-term disability cases that necessitate further review.

• Offer an additional layer of quality assurance for cases with identified quality concerns using clinical claims expertise.

• Participate in various duties and special projects as assigned.

• Examine reports accompanying medical records for precision and completeness.

⛳️ Requirements

• Experience in disability is mandatory.

• Preference for candidates with more than 5 years of claims experience.

• An Associate’s Degree or Bachelor’s Degree is preferred.

• Prior business experience in a healthcare and/or insurance environment is advantageous.

• Must demonstrate a sense of urgency and the ability to meet deadlines.

• Self-motivation and a strong commitment to performance excellence are essential.

• Exceptional written and verbal communication skills are required.

• Proficiency in navigating computer applications; familiarity with Google Chrome, Gmail, Docs, and Sheets is beneficial.

• Strong attention to detail is necessary.

• Outstanding communication abilities and a clear understanding of company business operations.

• Capability to apply critical thinking, manage time effectively, and adhere to specific deadlines.

• Proficient computer literacy and typing skills are essential.

• Must provide and maintain personal internet services.

• A stable internet connection is required for this remote work position.

🏝️ Benefits

• Medical, dental, and vision coverage for employees and their families.

• Optional life insurance for employees, spouses, and children.

• Plans for hospital indemnity, critical illness, accident indemnity, and pet insurance.

• Basic life insurance provided at no cost.

• Short-term disability coverage offered at no cost.

• Long-term disability coverage available at no cost.

• Generous paid time off policy.

• 401(k) plan with company matching contributions.

• Apple equipment provided for remote work setup.

• Media stipend to support a remote workspace.

• Opportunity for performance bonuses.

• Flexible remote work arrangement.