The Claims Quality Assurance role serves as the technical claims expert for the Claims Operations by auditing compliance with established CorVel, industry and carrier claim handling standards.
Requirements
- Model ethical behavior and executes job responsibilities in accordance with CorVel’s core values, ethics, and information protection policies
- Serve as technical QA lead to assigned offices or departments
- Lead QA projects and serve as primary coordinator for senior leadership of assigned offices
- Support the Claims Quality Assurance Program and the EC Operations Team in developing and implementing quality improvement strategies
- Lead the creation, presentation, execution, and calibration of Quality Assurance Training sessions
- Report on pending payments, reserves, Adjuster POA/Supervisor review compliance, leakage, and various reports to assess operational performance and compliance to CorVel standards
- Monitor claim financials; perform routine follow ups for audits identifying reserve deficiencies or pending aspects of claim liability or compensability; Ensure carrier reporting deficiencies have also been corrected
- Maintain and update in real time quality, quantity, and turn-time standards
- Conduct testing on software, websites, and other technical products to identify and resolve defects, and other potential claims processing issues
- Review claim process specifications to understand the scope, requirements, and function of each product
- Identify appropriate parameters, functions, and data to test and validate
- Conduct testing to ensure products perform according to user requirements and within established guidelines
- Submit operational QA reporting to EC Ops at durations outlined
- Participate in strategic operational calls with EC Operations and claims leadership when the QA process has identified a significant operational deficiency
- Work with EC Operations to insert QA corrective action plans required by a carrier or client
Benefits
- Medical (HDHP) w/Pharmacy
- Dental
- Vision
- Long Term Disability
- Health Savings Account
- Flexible Spending Account Options
- Life Insurance
- Accident Insurance
- Critical Illness Insurance
- Pre-paid Legal Insurance
- Parking and Transit FSA accounts
- 401K
- ROTH 401K
- Paid Time Off
