Ohio MCO Quality Coordinator

About the role

To ensure the consistent delivery of CorVel’s total Ohio MCO workers’ compensation solution through the development, implementation, and ongoing utilization of specific quality assurance tools and training leading to consistency and satisfied/loyal customers. This is a hybrid role.

Responsibilities

• Conduct quality reviews/audits to ensure appropriate management of the claims and office, score the office performance, and make suggestions and follow-up to ensure office has taken action on improvement recommendations.
• Identify and participate in training and developmental needs of the claims staff including the training/re-training of all offices on existing best practices and new procedures, including usages of the CorVel claim system.
• Provide back-up for incoming team calls when call volume is high and when phone reps are unavailable.
• Handle a variety of inquiries including, but not limited to claim reentry, call recording review and write-up, and miscellaneous manual steps required for claim completion.
• Quality Assurance—gather and handle forwarded daily QA emails.
• Provide back-up duties for completing outstanding emails.
• Provide leadership and case management support to assist in daily job tasks.
• Research and handle escalated calls and e-mails in lieu of a manager.
• Communicate changes and information as necessary.
• Run reports within system platform.
• Maintain knowledge of Ohio BWC rules and laws, workers’ compensation process, URAC standards, ODG, and policies and procedures.
• Provide team quality assurance for individuals to track monthly quality assurance.
• Maintain designated spreadsheets.
• Create quality assurance monthly and yearly reports for management.
• Create and implement new-hire and ongoing professional development training documents and testing for the Claims Management team.
• Perform claims management techniques to manage claims to optimal return to work and claim cost outcomes.
• Analyze and process complex or technically difficult claims by investigating and gathering information, managing claims through well-developed action plans to an appropriate and timely resolution.
• Develop and maintain medical knowledge and understanding of clinical practices.
• File necessary documentation with BWC and parties to the claim.
• Provide business-writing training for team members.
• Publish quarterly department newsletter which presents pertinent and needed information to the team.
• Complete miscellaneous MCO projects, as needed.
• Send anniversary emails to team, aka Terrific Tenures.
• Create and run reports, as requested.
• Additional duties as assigned.

Requirements

• Minimum two (2) years’ experience handling Ohio Workers’ Compensation claim adjudication.
• High School diploma or GED required.
• One year administrative experience required.
• Knowledge of BWC mandatory and expected EDI transmission elements.
• Good organizational and time management skills.
• PC literate with knowledge of Microsoft Office products.

Skills

• Excellent professional and effective verbal and written communication skills.
• Able to identify problems and get the broad view for potential and existing quality assurance cases.
• Ability to analyze complex quality assurance situations, share findings, and navigate toward an understandable solution.
• Strong knowledge and experience in quality assurance and training programs.
• Strong organizational skills.
• Able to listen and ask pertinent questions.
• Able to effectively and timely report representative quality assurance and customer issues, concerns, or problems to management.

Pay

CorVel uses a market-based approach to pay, with rates established considering federal, state, and local minimum wage requirements, geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Pay Range: $22.12 - 33.05 per hour.

Benefits

A comprehensive benefits package is available for full-time regular employees and includes:

• Medical (HDHP) with 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 and ROTH 401K
• Paid time off

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. Over 4,000 people working across the United States embrace core values of Accountability, Commitment, Excellence, Integrity, and Teamwork (ACE-IT!).