Claims Quality Assurance Specialist
1 week ago
The Claims Quality Assurance Specialist serves as the technical expert for the Claims Operations by auditing compliance with established CorVel, Industry and Carrier claim handling standards. The primary responsibility will be to evaluate claim handling quality, accuracy and timeliness in categories including but not limited to: Coverage analysis, investigation, valuation, reserving, compliance and accurate disposition of claims. The successful candidate will have the ability to interpret results and trends in order to deliver operational reporting, participate in the development and presentation of training.
This is a remote position.
**Essential Functions and Responsibilities:**
- Model ethical behavior and execute job responsibilities in accordance with CorVel's core values, ethics, and information protection policies.
- Serve as technical QA lead to assigned offices or various departments within assigned offices as needed.
- Lead QA projects and serve as primary coordinator on these to senior leadership of assigned offices.
- Support the Claims Quality Assurance Program and the EC Operations team in developing and implementing quality improvement strategies.
- Lead the creation, presentation, execution, and calibration of Quality Assurance training sessions. This includes integrating and delivering claims training programs in the context of Quality Assurance calibration exercises (e.g. policy, systems, workflows, statutes) and taking steps toward target results and the acquisition of target skills-sets. This also includes the creation, maintenance, and update of quality assurance training materials as necessary for use in quality assurance training sessions.
- Reports on pending payments, reserves, Adjuster POA/Supervisor review compliance, leakage, and various reports to assess operational performance and compliance to CorVel standards.
- Monitors claim financials; performs routine follow ups for audits identifying reserve deficiencies or pending aspects of claim liability or compensability. Ensures carrier reporting deficiencies have also been corrected.
- Maintain and update in real time quality, quantity, and turn-time standards.
- Will conduct testing on software, websites, and other technical products to identify and resolve defects, and other potential claims' processing issues.
- Reviews claim process specifications to understand the scope, requirements, and function of each product.
- Identifies appropriate parameters, functions, and data to test and validate; parameters may include general function, validity of results, accuracy, reliability, and compliance with industry standards.
- Conducts testing to ensure products perform according to user requirements and within established guidelines.
- When a product does not perform within specifications, reports defects to EC Operations and the BOT teams identifying and recommending solutions, improvements, and updates.
- Submits operational QA reporting to EC Ops at durations outlined; operational reporting to include written corrective action plans for areas of deficiency identified during the QA review process.
- Participates in strategic operational calls with EC Operations and claims leadership when the QA process has identified a significant operational deficiency.
- Works with EC Operations to insert QA corrective action plans required by a carrier or client.
**Knowledge and Skills:**
- Excellent written and verbal communication skills necessary for the communication of quality assessment scores/findings to collaborate with field claim operations, leadership, and EC Operations in applying solutions.
- Effective quantitative, analytical and interpretive skills.
- Excellent leadership and mentorship skills, with a demonstrated ability to motivate staff and obtain results through teamwork and education.
- Ability to function effectively under time constraints, consistently meet deadlines and handle multiple tasks in a demanding work environment.
- Computer proficiency and technical aptitude with the ability to utilize common computer applications.
- Strong interpersonal, time management, project management and organizational skills.
- Ability to maintain a high level of tact and professionalism.
- Knowledge of the entire claims administration procedures and processes including ancillary services.
- Ability to remain poised in stressful situations and communicate diplomatically via telephone, computer, fax, correspondence, etc.
- Ability to work independently or in a team environment while functioning as an educator rather than an auditor.
**Education/Experience:**
- Bachelor's Degree with course concentration in Business Administration, or related field; or 5+ years of equivalent combination of education and experience in a complex healthcare, insurance, or third party claim organization with significant claim management expertise.
- Must have significant industry experience and a deep understanding of CorVel's proprietary systems and solutions.
- Strong proficiency in Microsoft Office Suite is required
- Excellent written and verbal communication; demonstrated ability to provide superior service to internal and external stakeholders
- Ability to identify priorities, execute and multitask in a dynamic, fast paced environment.
- Certified Trainer and/or Quality Assurance experience a plus.
**Pay Range:**
CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time.
For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process.
Pay Range: $67,086 – $111,634
A list of our benefit offerings can be found on our CorVel website: CorVel Careers | Opportunities in Risk Management
In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first.
**About CorVel:**
CorVel, a certified Great Place to Work Company, is a national provider of industry-leading risk management solutions for the workers' compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT).
A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off.
CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable.
#LI-Remote
-
Claims Quality Assurance Specialist
4 weeks ago
Salem, Connecticut, United States CorVel Enterprise Comp, Inc. Full timeJob SummaryCorVel Enterprise Comp, Inc. is seeking a highly skilled Claims Quality Assurance professional to join our team. As a Claims Quality Assurance specialist, you will be responsible for ensuring the accuracy and timeliness of claims handling, identifying areas for improvement, and implementing quality control measures to maintain the highest...
-
Medical Claims Specialist
1 week ago
Salem, Connecticut, United States CorVel Enterprise Comp, Inc. Full timeJob Title: Medical Only Claims SpecialistJoin CorVel Enterprise Comp, Inc. as a Medical Only Claims Specialist and play a vital role in managing non-complex and non-problematic medical only claims and minor lost-time workers' compensation claims.Key Responsibilities:Manage claims from receipt to closure, ensuring timely and accurate processing.Determine...
-
Claims Specialist
5 days ago
Salem, Connecticut, United States CorVel Enterprise Comp, Inc. Full timeJob SummaryCorVel Enterprise Comp, Inc. is seeking a skilled Indemnity Claims Specialist to manage within company standards and best practices WC Indemnity claims. The ideal candidate will have the ability to determine benefits due, manage subrogation, and ensure specific customer service requirements to achieve the best possible outcome in the claim.This is...
-
Claims Manager
3 weeks ago
Salem, Connecticut, United States CorVel Enterprise Comp, Inc. Full timeJob Title: Claims ManagerCorVel Enterprise Comp, Inc. is seeking a highly skilled Claims Manager to join our team. As a Claims Manager, you will be responsible for the overall operation of a designated office, formulating and administering company best practices, and developing long-range goals and objectives.Key Responsibilities:Represent the company in a...
-
Claims Manager
3 days ago
Salem, Connecticut, United States CorVel Enterprise Comp, Inc. Full timeJob SummaryThe Claims Manager is responsible for overseeing the overall operation of a designated office, ensuring compliance with Workers' Compensation laws and regulatory requirements. This role involves formulating and administering company best practices, developing long-range goals and objectives, and analyzing costs, activities, and operations to...
-
Claims Supervisor
4 days ago
Salem, Connecticut, United States CorVel Enterprise Comp, Inc. Full timeJob SummaryCorVel Enterprise Comp, Inc. is seeking a highly skilled Claims Supervisor to join our team. As a Claims Supervisor, you will be responsible for supervising a team of direct reports, ensuring all quality, productivity, and customer service criteria are met while adhering to company policies and procedures.Key ResponsibilitiesSupervise claims staff...
-
Produce Specialist
4 days ago
Salem, Connecticut, United States Balls Foods Full timeJob OverviewBalls Foods is seeking a skilled Produce Specialist to join our team. As a Produce Specialist, you will be responsible for ensuring the freshest produce available for our customers.We offer a competitive compensation package, including weekly pay, teammate discount, referral bonus program, flexible hours, paid vacations, holiday pay,...
-
Ukrainian Language Specialist
1 week ago
Salem, Connecticut, United States Propio Language Services Full timeWe are seeking a highly skilled Ukrainian language specialist to join our team of contract interpreters at Propio Language Services. Our company is dedicated to closing the language gap by connecting people anywhere and anytime through innovative technology and solutions.As a Ukrainian language specialist, you will play a critical role in providing...
-
Procurement Specialist
2 weeks ago
Salem, Connecticut, United States LHH Recruitment Solutions Full timeJob OverviewWe are seeking a highly skilled Procurement Specialist to join our team at LHH Recruitment Solutions. The ideal candidate will be responsible for sourcing and purchasing materials, supplies, and equipment necessary for our operations, ensuring cost-effectiveness and quality.Key Responsibilities:Identify and evaluate potential suppliers based on...
-
Nurse Appeals Specialist
2 weeks ago
Salem, Connecticut, United States Elevance Health Full timeNurse Appeals SpecialistWe are seeking a skilled Nurse Appeals Specialist to join our team at Elevance Health. As a key member of our appeals team, you will be responsible for investigating and processing medical necessity appeals requests from members and providers.Key Responsibilities:Conduct thorough investigations and reviews of member and provider...
-
Sales Representative
2 weeks ago
Salem, Connecticut, United States AmeriPro Roofing Full timeJob OpportunityAmeriPro Roofing, a leading residential roofing contractor, is seeking an experienced Exterior Sales Representative to join our team in the Kansas City metro area.As an Exterior Sales Representative, you will educate and inform homeowners on their entitlements related to storm damage, roofing, siding, and gutter projects. You will protect...
-
Senior Care Coordinator RN
2 weeks ago
Salem, Connecticut, United States Brookdale Senior Living Full timeOverviewBrookdale Senior Living is seeking a highly skilled and compassionate Senior Care Coordinator RN to join our team. As a key member of our clinical services team, you will play a vital role in ensuring the highest quality of care for our residents.ResponsibilitiesConduct and coordinate resident assessments, ensuring compliance with state and federal...
-
Civil Drafter/Designer
1 week ago
Salem, Connecticut, United States JARBO Full timeJob DescriptionCivil Drafter/Designer Opportunity at JARBOWe are seeking a skilled Civil Drafter/Designer to join our team at JARBO. As a Civil Drafter/Designer, you will be responsible for creating detailed civil engineering drawings using Civil 3D CAD software.Key Responsibilities:Drafting and Designing: Utilize Civil 3D CAD software to create detailed...
-
Procurement Specialist
1 month ago
Salem, Connecticut, United States LHH Recruitment Solutions Full timeJob SummaryWe are seeking a skilled Buyer to join our team at LHH Recruitment Solutions in the Kansas City metro area. As a Buyer, you will be responsible for sourcing and purchasing materials, supplies, and equipment necessary for our operations, ensuring cost-effectiveness and quality.Key ResponsibilitiesIdentify and evaluate potential suppliers based on...
-
Procurement Specialist
3 weeks ago
Salem, Connecticut, United States LHH Recruitment Solutions Full timeJob OverviewWe are seeking a skilled Buyer to join our team at LHH Recruitment Solutions in the Kansas City metro. As a key member of our procurement team, you will be responsible for sourcing and purchasing materials, supplies, and equipment necessary for our operations, ensuring cost-effectiveness and quality.Key ResponsibilitiesIdentify and evaluate...
-
Nurse Specialist
1 week ago
Salem, Connecticut, United States AdventHealth Full timeJob SummaryAdventHealth Shawnee Mission is seeking a Registered Nurse to join our Cardiology Clinic team. As a Registered Nurse, you will provide high-quality patient care and assist with patient education.ResponsibilitiesProvide nursing care to patients and assist with patient educationAssist provider during treatment and examination of patient, and...
-
Karenni Language Specialist
2 months ago
Salem, Connecticut, United States Propio Language Services Full timePosition OverviewAt Propio Language Services, we are dedicated to bridging communication gaps through innovative technology and exceptional solutions. Since our inception in 1998, we have been committed to delivering vital interpreting and translation services that enhance the quality of life in the communities we serve. Our team consists of experienced...
-
Outpatient Mental Health Specialist
3 weeks ago
Salem, Connecticut, United States LifeStance Health Full timeWe are seeking a skilled Psychiatrist to join our team at LifeStance Health, a leading provider of mental health services.As a Psychiatrist with our organization, you will have the opportunity to work with a diverse patient population and provide high-quality care in an outpatient setting.**Key Responsibilities:**Provide comprehensive psychiatric evaluations...
-
Outpatient Mental Health Specialist
2 weeks ago
Salem, Connecticut, United States LifeStance Health Full timeWe are seeking a skilled Psychiatrist to join our team at LifeStance Health, a leading provider of mental health services.As a Psychiatrist with our organization, you will have the opportunity to work with a diverse range of patients and provide high-quality care in an outpatient setting.**Key Responsibilities:**Provide comprehensive psychiatric evaluations...
-
Talent Acquisition Specialist
2 months ago
Salem, Connecticut, United States HR Rethought Full timeJob OverviewPosition: RecruiterLocation: RemoteCompany: HR-RethoughtHR-Rethought is a consulting organization specializing in human resources, providing services to a diverse clientele across the nation. We collaborate with small to medium-sized enterprises, acting as their dedicated HR and recruiting partner. Our clientele spans various sectors, including...