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Independent Medical Examination Quality Reviewer

2 months ago

Southfield, United States MEDLOGIX, LLC Full time
Job Overview

Position Title: Claims Quality Assurance Reviewer
Company: MEDLOGIX, LLC
Location: Hybrid (2-3 days a week in office)

About MEDLOGIX: MEDLOGIX is dedicated to providing advanced medical claims solutions through effective collaboration of our innovative technology, skilled personnel, and extensive healthcare provider networks. Our focus is on meeting client needs with a commitment to excellence.

Role Summary: The Claims Quality Assurance Reviewer plays a crucial role in ensuring compliance with quality standards by verifying that all work products meet client specifications and regulatory requirements. This includes reviewing medical reports generated from Independent Medical Examinations (IME's), Peer Reviews, and other related documents.

Key Responsibilities:

  • Conduct thorough quality assurance evaluations of independent medical examination reports and peer review documents.
  • Ensure that all recommendations and determinations are supported by clear, evidence-based rationales.
  • Verify adherence to client instructions and specifications, addressing any queries as necessary.
  • Maintain the highest standards for report content, format, and professional presentation.
  • Identify and rectify any discrepancies within the reports.
  • Establish and maintain effective communication with medical professionals and legal representatives to ensure timely report delivery.
  • Assist in resolving client complaints and quality assurance challenges as required.
  • Stay proficient with company software and databases.

Qualifications:

  • A college degree is preferred, or equivalent experience in claims adjusting.
  • Strong time management, problem-solving, and organizational skills are essential.
  • Exceptional communication skills, with the ability to convey information accurately and listen effectively.
  • Commitment to confidentiality and the ability to foster a positive team environment.
  • Ability to maintain focus and work efficiently under pressure.
  • Proficiency in Microsoft Office applications is required.
  • Familiarity with claims and medical terminology, as well as experience with IME and Peer Review reports, is advantageous.

Diversity and Inclusion: MEDLOGIX is an equal opportunity employer and is committed to fostering a diverse workplace. We prohibit discrimination and harassment of any kind, ensuring a respectful environment for all employees.