Quality Assurance Specialist

US-CO-Westminster | US
1 month ago
Job ID
2017-1217
# of Openings
1
Category
Customer Service/Support

Overview

Who We Are: Reed Group is a dynamic, fast growing organization that works in a niche industry most commonly known as Third Party Administration. We are known for being a leader in managing absences for major companies including Fortune 100 companies. More specifically, instead of employers managing the process when an employee needs to go out on leave for FMLA (the family medical leave act) or for Short Term or Long Term Disability, we handle it for them. As a result we have a large customer operations team of talented individuals who manage our client’s employee cases.

We build the software (we have a large group of developers) to manage the entire work flow which is why you could easily think of us as a technology company. We also have a content business called MDGuidelines that contains treatment recommendations for best managing an employee back to work.

Right now we are over 1,900 employees (and growing daily).

 

The Reed Group Mission: We are about helping people get back to work. Often, this means helping people through difficult times in their lives. We help doctors do their best for their patients and we help employees protect their jobs. Our mission is: We believe there's a better way to help employers increase productivity, improve healthcare quality and help employees back to productive life.

Responsibilities

PURPOSE:

 

The Quality Assurance Specialist position is responsible to monitor colleague case management activities at a claim file level by conducting audits with a focus on identifying issues to ensure compliance with all state, federal and client plan requirements. The QA Specialist ensures audits and audit spreadsheets are completed accurately without error.

 

 

 

The ideal candidate has…

 

  • Excellent organizational and administrative skills
  • Prior recent experience with claims management in the Absence Management industry
  • Solid knowledge of FMLA, LOA, ADA, STD & LTD claim management practices
  • Demonstrated knowledge of operating systems and reporting
  • Cool under pressure, flexible and offers solutions
  • Can maintain confidentiality of internal and external clients in accordance with established Reed, federal and state policies
  • Thrives in a fast-paced environment that offers continuous challenges
  •  

 

ESSENTIAL FUNCTIONS:

 

Responsibilities

 

  • Conducts audits regarding the case manager’s handling of disability and leave claims in accordance with utilization guidelines, federal and state regulations and client plan provisions
  • Participates in quality improvement initiatives and offers opportunities for cost savings or other efficiencies through improvement of the case management process
  • Gathers and enters audit data timely in various Audit Tools and monthly/quarterly spreadsheets
  • Reviews audit rebuttals from operations teams and provides clear and timely auditor response to rebuttals
  • Participates in QA team & Calibration meetings
  • Can work independently but is a strong team player
  • Stays up-to-date with client specific processes and plan changes that impact QA and Performance Standard Auditing
  • Acts as a resource to Operational teams with regard to best practices as they relate to claim handling and client specific processes
  • Demonstrates adherence to ReedGroup values and performance guidelines
  • Other duties as required    

Qualifications

Qualifications

  • 3 to 5 years of recent experience in Absence Management industry (FMLA,LOA,ADA,STD, LTD)
  • Bachelor Degree preferred
  • Excellent interpersonal communications skills both verbal and written
  • Strong organizational and analytical skills
  • Self-starter and proven team player capable of prioritizing work and problems simultaneously
  • Comfortable working in a high-energy, quickly changing and demanding environment

Technology Experience and Familiarity

  • Intermediate Microsoft Office: Excel, Word, PowerPoint, Outlook
  • Collaboration Tools: Skype, Webex, SharePoint, etc.
  • Absence Management operating systems including: 360, V4, LeavePro and AM
  •  

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