Claims Quality Assurance Specialist

4 weeks ago

Salem, Connecticut, United States CorVel Enterprise Comp, Inc. Full time
Job Description

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

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