Clinical Auditor - Long Term Disability, RN
Description: • Overview: • Perform and summarize audits for improving overall performance of employees and quality of business. • Work directly with leadership to ensure...
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 Streets 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 Associates Degree or Bachelors 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. Apply Job!
• 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 Streets 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 Associates Degree or Bachelors 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. Apply Job!
