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Quality Control and Compliance Associate

1 month ago

Trenton, United States NJM Insurance Group Full time

Reporting to the Medical Services QC Supervisor in our West Trenton, New Jersey corporate office, the QC & Compliance Associate is responsible and accountable for conducting complete and thorough reviews of medical bills and participating in targeted compliance and process audits to support the department.

This role also supports the MSA QC Supervisor in completing compliance checklist reviews for both PIP and Workers' Compensation Claims. This is a hybrid position that requires at least three days a week in the office.

Job Responsibilities:

  • Assist the MSA QC Supervisor in completing PIP and WC compliance checklist reviews
  • Gather exhibits required, identify items needing sign off from other departments outside of MSA, and assist with compiling regulations for sign off
  • Establish audit parameters/thresholds, gather and compile data for closed claim and process audits for all identified MSA business units as specified by Department Supervisor
  • Prepare target audit samples using SAS EG, Excel, and/or other tools
  • Collect and report audit findings
  • Consolidate data into report for supervisor review
  • Identify trends or patterns
  • Perform pre- and post-payment audits on WC and PIP medical payment in accordance with established procedures. Accurately maintain and document audit findings. Identify trends or patterns in errors for supervisor
  • Perform ad hoc tasks assigned by the Supervisor and/or MSA Management

Required Skills & Qualifications:

  • High School diploma or GED required, bachelor's degree preferred
  • 2+ years proficient experience in using Microsoft, Excel and PowerPoint
  • Knowledge of the following systems a plus: Decision Point, Agile Point, Claim Center and Onbase
  • Team player with demonstrated ability to work in a highly collaborative environment
  • Good analytical, organizational and time-management skills
  • Decision-making and multi-tasking capabilities
  • Strong verbal and written communication skills

Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.

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