Disability Claims Quality Assurance Specialist

1 week ago

Palm Beach Gardens, Florida, United States Dane Street, LLC Full time
Job Title: Disability Claims Quality Assurance Specialist

Job Summary:

We are seeking a highly motivated and detail-oriented Disability Claims Quality Assurance Specialist to join our team at Dane Street, LLC. As a Disability Claims Quality Assurance Specialist, you will play a critical role in ensuring the accuracy and completeness of reports accompanying medical records for Long Term Disability claims.

Key Responsibilities:

  • Assess the quality of physician reports to ensure they meet client and jurisdictional standards for Long Term Disability claims.
  • Verify that claims support physician determinations in Long Term Disability claims.
  • Apply policy guidelines and healthcare terminology to determine when criteria for Long Term Disability are met.
  • Provide exceptional customer service by working closely with clients on a case-by-case basis to deliver complete, timely, and error-free quality assurance for Long Term Disability cases.
  • Manage and provide oversight for complex Long Term Disability cases requiring additional review prior to returning to the client.
  • Serve as an additional level of QA for cases with quality issues, utilizing clinical claims knowledge specific to Long Term Disability.
  • Participate in other duties and special projects as assigned based on business needs.

Requirements:

  • An Associate's Degree or Bachelor's Degree is preferred.
  • RN preferred.
  • 5+ years of claims experience, preferred.
  • Long Term Disability experience required.
  • Business experience in a healthcare and/or insurance setting is preferred.
  • Must work with a sense of urgency and meet deadlines.
  • Must be self-motivated, with a strong drive for performance excellence.
  • Excellent written and verbal communication skills are required.
  • Proficiency in navigating a variety of computer programs is essential.
  • Attention to detail is REQUIRED.

Benefits:

We offer a comprehensive benefits package designed to support your well-being and peace of mind. This includes medical, dental, and vision coverage for you and your family, as well as voluntary life insurance options, hospital indemnity, critical illness, accident indemnity, and pet insurance plans. Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. Apple equipment and a media stipend are provided for remote workspace.

About Dane Street, LLC:

Dane Street, LLC is a fast-paced, Inc. 500 Company with a high-performance culture. We process over 200,000 insurance claims annually for leading national and regional Workers' Compensation, Disability, Auto, and Group Health Carriers, Third-Party Administrators, Managed Care Organizations, Employers, and Pharmacy Benefit Managers. We provide customized Independent Medical Exams and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.

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