Clinical Auditor - Long Term Disability, RN

2 days ago

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Dane Street

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IMEs • Physician Advisor Reviews • Peer Reviews • Drug Utilization Reviews

51 - 200

Description

• Overview: • Perform and summarize audits for improving overall performance of employees and quality of business. • Work directly with leadership to ensure assigned training is appropriate. • Summary: • 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. • Key Responsibilities: • Conducts scheduled audits as well as ad hoc audits. • Provide summary and recommendations. • Implement corrective actions recommended by clients. • Identifies areas where issues exist and works with appropriate individuals to ensure resolution. • Provide aspects of training to employees in specific assigned departments. • Manage and provide oversight for complex long-term disability cases requiring additional review prior to returning to the client. • Serve as an additional level of QA for cases with quality issues, utilizing clinical claims knowledge specific to long-term disability. • Participate in other duties and special projects, as assigned, based on business needs.

Requirements

• EDUCATION/CREDENTIALS: • An Associate’s Degree or Bachelor’s Degree is preferred. • RN required. • JOB RELEVANT EXPERIENCE: • 5+ years of claims experience, preferred. • Long Term Disability experience required. • Business experience in a healthcare and/or insurance setting is preferred. • Must work with a sense of urgency and meet deadlines. • Must be self-motivated, with a strong drive for performance excellence. • Excellent written and verbal communication skills are required. • Proficiency in navigating a variety of computer programs (Experience with Google Chrome, Gmail, Docs, Sheets, etc. is a plus). • Attention to detail REQUIRED. • 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.

Benefits

• Join our team at Dane Street and enjoy a comprehensive benefits package designed to support your well-being and peace of mind. • We offer a range of benefits including medical, dental, and vision coverage for you and your family. • Additionally, we offer voluntary life insurance options for you, your spouse, and your children. • We also offer other voluntary benefits which include hospital indemnity, critical illness, accident indemnity, and pet insurance plans. • Employees receive basic life insurance, short-term disability, and long-term disability coverage at no cost. • Our generous paid time off policy ensures you have time to relax and recharge, while our 401k plan with a company match helps you plan for your future. • Apple equipment and a media stipend are provided 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.