Worker’s Compensation Reports Reviewer

Have you worked with Workers' Comp, Bodily Injury, and/or Disability Claims? Brimming with expertise in the medical, insurance and/or legal background and eager to apply it somewhere? 

Well, consider applying for our Worker’s Compensation Reports Reviewer role (internally called a Quality Assurance Coordinator) position at Roseland, NJ (onsite). 

Our essential Coordinators reviews the internal Independent Medical Exams (IME) reports and ensure the IMEs are completed at the highest level of quality and integrity. Not only ensuring they are in full compliance, but also handles the inquiries and provides strong support to the department.

This is a full-time Monday-Friday 8-5pm schedule.

• Performs quality assurance review of IME reports, correspondences, addendum's or supplemental reviews.
• Review reports for grammar, medical terminology and content accuracy. 
• 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.
• Ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from reputable medical journals and/or publications.
• Ensures the content, format, and professional appearance of the reports are of the highest quality and in compliance with company standards.
• Ensure that the appropriate board specialty has reviewed the case in compliance with client specifications and/or state mandates and is documented accurately on the case report.
• Verifies that the peer reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Identifies any inconsistencies within the report and contacts the Provider to obtain clarification, modification or correction as needed.

REQUIREMENTS:

• High school diploma or equivalent required.
• 2 years of experience with IME or insurance industry preferably claims management relative to one or more of the following categories:
  • workers' compensation, no-fault, liability, and/or disability.
• Must have strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values.

QUALIFICATIONS: 

• Must be knowledgeable of multiple software programs, including but not limited to Microsoft Word, Outlook, Excel, and the Internet.
• Must possess excellent skills in English usage, grammar, punctuation and style.
• Demonstrates accuracy and thoroughness. 
• Must be able to work independently, prioritize work activities and use time efficiently.
• Must possess the ability to manage change, delays, or unexpected events appropriately.
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Who we are:

ExamWorks is a leading provider of innovative healthcare services including independent medical examinations, peer reviews, bill reviews, Medicare compliance, case management, record retrieval, document management and related services. Our clients include property and casualty insurance carriers, law firms, third-party claim administrators and government agencies that use independent services to confirm the veracity of claims by sick or injured individuals under automotive, disability, liability and workers' compensation insurance coverages.

ExamWorks, LLC is an Equal Opportunity Employer and affords equal opportunity to all qualified applicants for all positions without regard to protected veteran status, qualified individuals with disabilities and all individuals without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age or any other status protected under local, state or federal laws.

Equal Opportunity Employer - Minorities/Females/Disabled/Veterans

ExamWorks offers a fast-paced team atmosphere with competitive benefits (medical, vision, dental), paid time off, and 401k.

Tags:

Paralegal

Claims Adjuster

Claims Examiner

Civil Litigation

IME

Medical Records