Quality Assurance Nurse — Remote/Hybrid Claims QA

MEDLOGIX, LLC; Hamilton (NJ); Híbrido; USD 83 097 000 - 91 693 000; Tempo integral

Resumo da oferta

Medlogix, LLC in Hamilton, NJ seeks a Quality Assurance Nurse for a hybrid role, combining remote work with occasional in-office days. The position involves reviewing IME and peer review reports, ensuring accuracy, consistency, and adherence to client specifications.

You will coordinate with physicians, adjusters, and paralegals to meet deadlines, maintain documentation quality, and uphold confidentiality while supporting a high-standard claims process.

Qualificações

• College degree preferred or years of experience in claims adjusting, nursing degree preferred but not required.
• Excellent time management, problem solving and organizational skills and the ability to work independently are required.
• Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
• Must be able to maintain confidentiality.
• Must be able to promote a positive team-oriented environment.
• Must be able to stay focused and concentrate under normal or heavy distractions.
• Must be able to work well under pressure and/or stressful conditions.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
• Demonstrates reliability and abides by the company attendance policy.
• Proficiency in Microsoft Office applications is essential.
• Knowledge of claims/medical terminology and/or No Fault, Workers Compensation or Liability is preferred.
• Experience reading IME and/or Peer Review reports is preferred but not required.

Responsabilidades

• Performs quality assurance review of independent medical examination reports, peer review reports, correspondences, addendums or supplemental reviews.
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations.
• Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Identifies any inconsistencies within the report.
• Contact and maintain rapport with physicians and adjusters/attorneys/paralegals to ensure timely delivery of reports, monitor turnaround time.
• Assists in resolution of customer complaints and quality assurance issues as needed.
• Maintain proficiency with company computer systems and databases.

Conhecimentos

Time management

Problem solving

Organizational skills

Communication skills

Confidentiality

Team oriented

Pressure resilience

Microsoft Office

Formação académica

College degree preferred

Nursing degree preferred but not required

Ferramentas

Microsoft Office

Descrição da oferta de emprego

Medlogix, LLC in Hamilton, NJ seeks a Quality Assurance Nurse for a hybrid role, combining remote work with occasional in-office days. The position involves reviewing IME and peer review reports, ensuring accuracy, consistency, and adherence to client specifications.

You will coordinate with physicians, adjusters, and paralegals to meet deadlines, maintain documentation quality, and uphold confidentiality while supporting a high-standard claims process.