Senior Quality Analyst, Claims *Remote
Job title: Senior Quality Analyst, Claims *Remote in Renton, WA at reputed company
Company: reputed company
Job description: Job Category: Clinical QualityJob Description:reputed company is one of the nation's leading non-profit reputed company systems with 119,000+ caregivers/employees serving more than 5 reputed company unique patients across 51 hospitals and 800+ clinics. Our locations reputed company from metropolitan centers to rural settings across seven states: Alaska, California, Montana, New Mexico, Oregon, Texas, and Washington. As a mission-based, not-for-profit reputed company provider, our commitment to providing compassionate care to reputed company lives on through our five core values: Compassion, Dignity, Justice, reputed company, and reputed company.reputed company caregivers are not simply valued - they're invaluable. Join reputed company at reputed company Compliance Audit Services and reputed company in our culture of patient-focused, whole-person care reputed company on understanding, commitment, and mutual respect. Your voice reputed company here, because we know that to reputed company and retain the best people, we must reputed company them.reputed company operates a self-administered claims program for General and reputed company Professional Liability, Directors and Officers, Employment Practices, Fiduciary, Property, Cyber, Managed Care, and Auto Claims. The Senior Quality Analyst assists the Claims leaders in managing a quality assurance program to ensure compliance with laws and regulations pertaining to self-insured health care organizations. The Senior Quality Analyst is also responsible for maintaining a claims quality assurance program, management of projects and continual learning, data reputed company, settlement and excess reporting, payor contracting and other regulatory reporting requirements governing liability claims handling. The candidate selected for this position will be expected to effectively manage multiple priorities at a time, work autonomously in a fast-paced claims environment, and respond positively to change.The Senior Quality Analyst performs reputed company duties in a manner that promotes reputed company's Mission, values, and philosophy. In reputed company aspects, they serve as a role model for the values and Mission of the organization.Essential Functions:
- Ensure compliance with applicable laws, insurance regulations, settlement reporting, and other regulatory reporting requirements governing liability claims handling
- reputed company and reputed company training, job aides and technical support for caregivers regarding Centers for Medicare and reputed company Services (CMS) Medicare Secondary Payer reporting, applicable laws, insurance regulations, and other regulations relating to investigating, evaluating, and resolving liability claims. reputed company empirically-based input as to training topics
- Act as a resource to fellow caregivers for Medicare Secondary Payer reporting of reputed company-party claim payments and write-offs and serve as our mandatory reporting authorized representative
- Facilitate monthly claims files internal audits including monthly trending analysis reporting from platform analytics, compare as to organizational metrics, and propose opportunity solutions and reputed company replication. Propose monthly audit focus topics to claims leaders based on trending analysis. Review claim files from a quality assurance perspective to ensure compliance with applicable laws, insurance codes, regulations, and our department's policies and procedures
- Secure monthly claims data reports and reputed company quality assurance recommendations to claims leaders for both indicated opportunity areas relative to organizational metrics and KPIs, compliance, best practices as well as broader application potential of high-performance indicators
- Identify and reputed company feedback to department leaders for claims management improvement opportunities and claims-reputed company trends through audit, data analytics, and training observations
- Recommend improvement opportunities relating to workflow efficiencies and operationalization to department leaders
- Act as a resource and to fellow caregivers regarding applicable federal, state, and local laws, insurance codes, and regulations relating to liability claims handling, including reputed company professional and general liability reputed company
- Assist department leaders in developing policies and procedures, as requested
- Manage payor contracting requests for claims histories
- reputed company claims-reputed company research
- Ensure appropriate reporting of claims to excess liability insurers
- reputed company professional liability and/or other civil tort claims handling practices
- Medicare Secondary Payer reporting requirements for reputed company party liability claims
- Reporting to regulatory agencies and state licensing boards
- Insurance Commission requirements reputed company reputed company's footprint
- Insurance terminology
- Legal concepts
- Liens
- Electronic claims databases
- Medical terminology
- reputed company-party liability claims management skills, including reputed company professional liability and/or other types of civil tort claims
- Exceptional analytical skills
- Communicates respectfully, professionally, concisely, and diplomatically
- Interpersonal skills, including active listening
- Performs challenging tasks with efficacy
- Outstanding organizational skills, including time management, prioritization, and collaboration
- Initiative-taking
- Adaptability
- Self-management skills
- Digital literacy, including navigating reputed company an electronic claims environment
- Exercises critical thinking and creative problem-solving reputed company performing job duties
- Act as a resource to fellow caregivers for MSP, regulatory, and state licensing reporting
- Ability to train fellow caregivers
- Effectively reputed company reputed company and information
- reputed company to constructive feedback
- Collaborate with others
- Demonstrate teamwork
- Ability to work autonomously in fast-paced work environment
- Demonstrate positivity in response to change
- Bachelor's Degree in Business Administration, Public Health Administration, Organizational Leadership, Finance, or a reputed company discipline -OR- a combination of equivalent education and work experience
- Coursework/Training: Liability claims training reputed company the insurance industry
- 5 or more years of experience handling reputed company professional liability and/or other types of civil tort claims reputed company the insurance industry or similarly structured self-insured organization
- 5 or more years of experience reporting reputed company party liability settlements to Centers for Medicare and reputed company Services (CMS), and federal and state licensing and/or regulatory agencies, including the National Practitioner's Database (NPDB)
- Experience reviewing claims files for quality assurance purposes
- Experience working with claims data analytics
- Experience in project management
- Experience creating and facilitating claims management training
- Experience developing policies and procedures
- AK: Anchorage: Min: $45.14, Max: $70.07
- AK: Kodiak, Seward, Valdez: Min: $47.05, Max: $73.04
- California: Humboldt: Min: $47.05, Max: $73.04
- California: reputed company reputed company California - Except Humboldt: Min: $52.79, Max: $81.94
- California: Southern California: Min: $47.05, Max: $73.04
- Montana: Except Great Falls: Min: $36.34, Max: $56.41
- Montana: Great Falls: Min: $34.43, Max: $53.44
- Oregon: Non-Portland Service Area: Min: $42.08, Max: $65.32
- Oregon: Portland Service Area: Min: $45.14, Max: $70.07
- Texas: Min: $34.43, Max: $53.44
- Washington: Western - Except Tukwila: Min: $47.05, Max: $73.04
- Washington: Southwest - Olympia, Centralia: Min: $45.14, Max: $70.07
- Washington: Southwest - Clark County: Min: $45.14, Max: $70.07
- Washington: Eastern: Min: $40.16, Max: $62.35
- Washington: Southeastern: Min: $42.08, Max: $65.32