Claims Quality Analyst, NY

Job Summary

The Quality Analyst is responsible for managing the various aspects of the medical file review process. They will review the completed referral to ensure client questions have been addressed appropriately and review the completed report for accuracy. Ensuring client and department standards have been met. Dane Street's success relies on individual and team contributions every day. We care for our customers, each other and Dane Street. It is the responsibility for all of us to maintain a positive working environment that promotes client satisfaction and results.

Major Duties & Responsibilities

• Reviews reports accompanying medical records to ensure that the report is complete and that all questions posed by the client have been addressed
• Follows up with the reviewer with any additional questions or clarifications needed
• Follows up with the client should there be any additional questions
• Updates clients frequently on referral progress
• Ensures the report is grammatically correct with no spelling errors
• Ensures each referral adheres to the QA checklist prior to the completion
• Formats reports for approval

Communication

• Communicates clearly and concisely between the customer, reviewer, and Operations team
• Must confidently speak with physicians and clients regarding the content of their peer reviews

Education/Credentials

An Associate's Degree or Bachelor's Degree is preferred.

Job Relevance Experience

Business experience in a healthcare and/or insurance setting is preferred. NY Workers Compensation Experience Is Preferred. Operations experience with Peer Review, UR and/or case management. Working with technology based processes within the business environment.

Job Related Skills/Competencies

• Present exceptional communication skills with a clear understanding of company business lines
• The ability to apply critical thinking, manage time efficiently and meet specific deadlines
• Computer literacy and typing skills are essential
• Ability to handle high volume and meet deadlines

Working Conditions/Physical Demands

• Any lifting, bending, traveling, etc. required to do the job duties listed above
• Long periods of sitting and computer work

Work From Home Technical Requirements

• Supply and support their own internet services
• Maintaining an uninterrupted internet connection is a requirement of all work from home position

Benefits

• Medical, dental, and vision coverage for you and your family
• Voluntary life insurance options for you, your spouse, and your children
• Voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans
• Basic life insurance, short-term disability, and long-term disability coverage at no cost
• Generous paid time off policy
• 401k plan with a company match
• Apple equipment and a media stipend for remote workspace

About Dane Street

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful forward-thinking professionals. 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.