Claims Quality Analyst

Summary

Join Dane Street's team as a Quality Analyst and manage various aspects of medical file review. Review completed referrals to ensure client questions are addressed and reports are accurate, adhering to client and department standards. Conduct quality audits of reports accompanying medical records, following up with reviewers and clients as needed. Maintain clear communication between customers, reviewers, and the operations team, confidently interacting with physicians and clients. Additional responsibilities include formatting reports and handling other duties as assigned. The position requires strong communication and critical thinking skills, along with computer literacy. A degree is preferred, as is experience in healthcare or insurance, particularly with NY Workers' Compensation.

Requirements

• 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
• Ability to handle high volume and meet deadlines
• Supply and support their own internet services
• Maintaining an uninterrupted internet connection is a requirement of all work from home position

Responsibilities

• Reviews reports accompanying medical records to ensure that the report is complete and that all questions posed by the client have been addressed
• Follows up with the reviewer with any additional questions or clarifications needs
• Follows up with the client should there be any additional questions
• Updates clients frequently on referral progress
• Ensures the report is grammatically correct with no spelling errors
• Ensures each referral adheres to the QA checklist prior to the completion
• Formats reports for approval
• Communicates clearly and concisely between the customer, reviewer, and Operations team
• Must confidently speak with physicians and clients regarding the content of their peer reviews
• Other duties & special projects, as assigned and based on business needs

Preferred Qualifications

• An Associate’s Degree or Bachelor’s Degree is preferred
• Business experience in a healthcare and/or insurance setting is preferred
• NY Workers Compensation experience is preferred
• Operations experience with Peer Review, UR and/or case management. Working with technology based processes within the business environment

Benefits

• Medical, dental, and vision coverage for you and your family
• Voluntary life insurance options for you, your spouse, and your children
• Other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans
• Basic life insurance, short-term disability, and long-term disability coverage at no cost
• Paid time off
• 401k plan with a company match
• Apple equipment and a media stipend are provided for remote workspace