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IME Claims Reviewer

3 months ago

Southfield, United States MEDLOGIX, LLC Full time
Job DescriptionJob DescriptionJob Title: Claims Reviewer/ QA Reviewer
Location: Southfield, Michigan (Hybrid, 2-3 time a week in MI office)

MEDLOGIX delivers innovative medical claims solutions through a seamless collaboration of our Integrity technology, our highly skilled staff, access to our premier health care provider networks, and our commitment to keeping our clients’ needs as our top priority. Integrity has a powerful mix of medical expertise, proven processes and innovative technology that delivers a more efficient, disciplined insurance claims process. The result is lower expenses and increased productivity for the auto insurance and workers’ compensation insurance carriers; third party administrators (TPAs); and government entities we serve.

This position is primarily responsible for maintaining quality compliance by identifying specific requirements and ensuring the work product is completed to client specifications and/or state mandates. “Work Product” in this case constitutes medical reports deriving from Independent Medical Examinations (IME’s), Peer Reviews and other medical reports.

ESSENTIAL DUTIES AND RESPONSIBILITIES:

Core duties and responsibilities include the following. Other duties may be assigned.

  • Performs quality assurance review of independent medical examination reports, 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.
  • Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
  • Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
  • Identifies any inconsistencies within the report.
  • Contact and maintain rapport with physicians and adjusters/attorneys/paralegals to ensure timely delivery of reports, monitor turnaround time.
  • Assists in resolution of customer complaints and quality assurance issues as needed.
  • Maintain proficiency with company computer systems and databases.

MINIMUM REQUIREMENTS:

  • College degree preferred or years of experience in claims adjusting.
  • Excellent time management, problem solving and organizational skills and the ability to work independently are required.
  • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
  • Must be able to maintain confidentiality.
  • Must be able to demonstrate and promote a positive team-oriented environment.
  • Must be able to stay focused and concentrate under normal or heavy distractions.
  • Must be able to work well under pressure and/or stressful conditions.
  • Must possess the ability to manage change, delays, or unexpected events appropriately.
  • Demonstrates reliability and abides by the company attendance policy.
  • Proficiency in Microsoft Office applications is essential.
  • Knowledge of claims/medical terminology and/or No Fault, Workers Compensation or Liability is preferred.
  • Experience reading IME and/or Peer Review reports is preferred.

MEDLOGIX provides equal employment opportunities to all employees and applicants for employment and prohibits discrimination and harassment of any type without regard to race, color, religion, age, sex, national origin, disability status, genetics, protected veteran status, sexual orientation, gender identity or expression, or any other characteristic protected by federal, state or local laws.This policy applies to all terms and conditions of employment, including recruiting, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation and training.