• Quality Assurance Analyst

    Requisition ID
    2018-2615
    # of Openings
    1
    Category
    Operations
    Location
    US-NY-Cheektowaga, NY
  • Overview

    The Quality Assurance Analyst is responsible to ensure IME client response times and reports are the highest level of quality and integrity and in full compliance with client contractual agreement, regulatory agency standards and/or federal and state mandates. This position is required to ensure that our client interfacing processes and procedures are meeting corporate and business unit expectations.  Must have prior New York State Claims experience.

    Responsibilities

    ESSENTIAL DUTIES AND RESPONSIBILITIES TO PERFORM THIS JOB SUCCESSFULLY INCLUDE, BUT ARE NOT LIMITED TO THE FOLLOWING:

    • Closely monitors all queues and performs quality assurance review of client referral response times and timely report processing.
    • Alerts and prompts appropriate department staff of cases in queue with no action for a period exceeding the target response or processing time and escalates to General Manager as necessary.
    • 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.
    • Provides management with daily audits of queues and lists potential issues.
    • Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
    • Researches escalations for resolution.
    • Identifies breakdowns in process and areas for improvement and/or training.
    • Escalates issues to General Manager that need immediate review and or resolution.
    • Handles calls and or emails from disgruntled clients.
    • Proofs and finalizes reports.
    • Completes special projects for management and performs other duties as assigned.

    Qualifications

    EDUCATION AND EXPERIENCE

    • High school diploma or equivalent required.
    • Two years IME experience preferred. Knowledge of the insurance industry preferably claims management relative to one or more of the following categories: workers' compensation, no-fault, liability, and/or disability preferred.

    QUALIFICATIONS 

    • Qualified typist with a minimum of 40 W.P.M preferred.
    • Must be able to operate a general computer, fax, copier, scanner, and telephone.
    • Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
    • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
    • Must possess excellent skills in English usage, grammar, punctuation and style.
    • Ability to follow instructions and respond to upper managements’ directions accurately.
    • Demonstrates accuracy and thoroughness. Looks for ways to improve and promote quality and monitors own work to ensure quality is met.
    • Must demonstrate exceptional communication skills by conveying necessary information accurately, listening effectively and asking questions where clarification is needed.
    • Must be able to work independently, prioritize work activities and use time efficiently.
    • Must be able to maintain confidentiality.
    • Must be able to demonstrate and 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.
    • Must maintain a professional and clean appearance at all times consistent with company standards.
    • Ability to read, analyze and interpret common correspondence, medical records, itemized billing statements and/or legal contracts and documents.
    • Ability to write clearly and informatively to all required audiences and edit own work for appropriate spelling and grammar.
    • Ability to respond appropriately and professionally to all inquiries or complaints from clients, physicians, upper management, regulatory agencies, and/or members of the business community.
    • Ability to effectively present information one-on-one, in small groups, and/or clients or vendors of the company.

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