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Worker's Comp Quality Assurance Specialist
San Diego, CA
Job Description
Mitchell International
Worker's Comp Quality Assurance Specialist
US--Remote
Job ID: 24-16803
Type: Regular Full-Time
# of Openings: 1
Category: Customer Service & Support
Mitchell International, Inc.
Overview
The Enlyte Family of Businesses
Mitchell | Genex | Coventry
Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.
Responsibilities
The Work Comp Quality Assurance Specialist. is responsible for ensuring processes, adherence to compliance processes and protocols, coordination of activities so that customer service and satisfaction is ensured and that regulatory compliance requirements are met.
Duties and responsibilities
- Performs quality assurance review of multiple State Work Comp Fee Schedules for accuracy on peer review reports, correspondences, addendums or supplemental reviews.
- Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations when preforming quality assurance based on Work Comp Fee Schedule guidelines.
- Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
- When required ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from current Work Comp Fee Schedule Guidelines and/or reputable medical journals.
- Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
- Ensure that the appropriate medical specialty has reviewed the case in compliance with client specifications and/or State Fee Schedule and is documented accurately on the case report.
Qualifications
- HS Diploma or equivalent
- 2-4 years of workers comp Bill Review experience
- Remote employees in this position will be expected to ensure the protection of proprietary Company and customer information accessible from their home or satellite office. Steps include, but are not limited to, use of locked file cabinets, disk boxes and desks, regular password maintenance, and any other steps appropriate for the job and the environment
Benefits
We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. Compensation depends on the applicable US geographic market. The expected base pay for this position ranges from $18.65 - $25.48 hourlyand will be based on a number ofadditional factors, including skills, experience, and education. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles. #LI-RM1
Salary: $18.65 - $25.48 hourly
Please see job description
PI239745586
Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full or Part Time
Required Education
High School or Equivalent
Required Experience
2 to 4 years
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