Case Coordinator (31828)

About the role

The Case Coordinator plays a critical role in ensuring medical reports meet the highest standards of accuracy, integrity, and regulatory compliance.

Responsibilities

• Performs quality assurance review of reports, correspondences, addendums or supplemental reviews.
• Sets clear, concise, evidence-based rationales for all recommendations and/or determinations.
• Fulfills client instructions and specifications, addressing all questions.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Verifies that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
• Identifies and addresses inconsistencies within the report, contacting the Peer Reviewer for clarification, modification, or correction as needed.
• Aids in resolving customer complaints and quality assurance issues as needed.
• Ensures adherence to federal ERISA and/or state mandates at all times.
• Provides insights and direction to management on consultant quality, availability, and compliance with all company policies and procedures and client specifications.
• Promotes effective and efficient utilization of company resources.
• Participates in various educational and/or training activities as required.
• Performs other duties as assigned.

Qualifications

• High school diploma or equivalent required.
• Minimum of two (2) years of clinical or related field experience, or an equivalent combination of education and experience.
• Knowledge of the insurance industry preferred, particularly claims management related to: Workers’ compensation, No-fault, Liability, Disability.

Essential Competencies & Qualifications

• Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.
• Ability to add, subtract, multiply, and divide in all units of measure, using whole numbers and decimals; ability to compute rates and percentages.
• Qualified typist with a minimum of 40 W.P.M.
• Knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Excellent skills in English usage, grammar, punctuation and style.
• Ability to accurately follow instructions and respond to directions from upper management.
• Exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Able to work independently, prioritize work activities and use time efficiently.
• Able to maintain confidentiality.
• Demonstrates reliability and abides by the company attendance policy.