Disability Claims Examiner, Sr. jobs in Boca Raton, FL

Dane Street is looking for highly motivated candidates to join our team as a Disability Claims QA. Dane Street offers an exciting work environment, competitive compensation and a strong growth potential.

As a Disability Claims QA, you will apply your claims knowledge to review reports accompanying medical records to ensure that the report is complete. You will communicate with physician reviewers and their office teams to ensure clarity of information and to ensure all questions posed have been addressed, and to ensure that reports are returned within client deadlines.

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.

MAJOR DUTIES & RESPONSIBILITIES

• Evaluates the quality of the physician's report and determines if the report will meet all client and jurisdictional standards.
• Ensures that the claims support the physician’s determinations.
• Read & apply policy guidelines, healthcare terminology and delineate when criteria is/is not met.
• Provides strong customer service skills and works closely with clients on a case-by-case basis to provide complete, timely and error free quality assurance of cases.
• Provides oversight to cases that are complex and need additional review prior to return to the client.
• Serves as an additional level of QA and clinical claims knowledge/review for cases with quality Issues.
• Other duties & special projects, as assigned and based on business needs.

EDUCATION/CREDENTIALS:

• An Associate’s Degree or Bachelor’s Degree is preferred.
• RN preferred.

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.

WORKING CONDITIONS/PHYSICAL DEMANDS:

• Any lifting, bending, traveling, etc. required to do the job duties listed above. Long periods of sitting and computer work.

WORK FROM HOME TECHNICAL REQUIREMENTS:

• Supply and support their own internet services.
• Maintaining an uninterrupted internet connection is a requirement of all work from home position.

This job description is subject to change at any time.

We offer generous Paid Time Off, excellent benefits package and a competitive salary. Apple equipment and media stipend is provided for remote work space. Come up to speed quickly with our strong training program! If you want to work in an exciting, fast-paced environment where you can provide meaningful contributions, then we encourage you to apply.

ABOUT DANE STREET:

A fast-paced, Inc. 500 Company with a high-performance culture, is seeking insightful, astute 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 Exam and Peer Review programs that assist our clients in reaching the appropriate medical determination as part of the claims management process.