Workers' Comp Quality Assurance Specialist

The Enlyte Family of Businesses

Mitchell | Genex | Coventry

Enlyte is the parent brand of Mitchell, Genex and Coventry, an organization unlike any other in the Property & Casualty industry, bringing together three great businesses with a shared vision of using technology innovation, clinical services and network solutions to help our customers and the people they serve. Our suite of products and services enable our employees to help people recover from challenging life events, while providing opportunities for meaningful impact and career growth.

The Work Comp Quality Assurance Specialist. is responsible for ensuring processes, adherence to compliance processes and protocols, coordination of activities so that customer service and satisfaction is ensured and that regulatory compliance requirements are met.

Duties and responsibilities

• Performs quality assurance review of multiple State Work Comp Fee Schedules for accuracy on peer review reports, correspondences, addendums or supplemental reviews.
• Ensures clear, concise, evidence-based rationales have been provided in support of all recommendations and/or determinations when preforming quality assurance based on Work Comp Fee Schedule guidelines.
• Ensures that all client instructions and specifications have been followed and that all questions have been addressed.
• When required ensures each review is supported by clinical citations and references when applicable and verifies that all references cited are current and obtained from current Work Comp Fee Schedule Guidelines and/or reputable medical journals.
• 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 medical specialty has reviewed the case in compliance with client specifications and/or State Fee Schedule and is documented accurately on the case report.

• HS Diploma or equivalent
• Must have 2-4 years of workers comp Bill Review experience
• Remote employees in this position will be expected to ensure the protection of proprietary Company and customer information accessible from their home or satellite office. Steps include, but are not limited to, use of locked file cabinets, disk boxes and desks, regular password maintenance, and any other steps appropriate for the job and the environment

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