Qa Specialist 3

Company Overview
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.
Job Description
The 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 in regard to the final product/report.
Perks: Full and comprehensive benefits programs starting on your first day, 24 days of paid vacation/holidays in your first year plus sick days, Employee Assistance and a Referral Program
Job Responsibilites:

• Ensures that all client instructions and specifications have been followed
• Ensure that the appropriate medical 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 reviewer has attested to only the fact(s) and that no evidence of reviewer conflict of interest exists.
• Ensures the provider credentials and signature are on the final report.
• Fax AP Teleconference Letters, AP Questions, and Opinion Letters for Readers to claimant's AP to sign and fax back to our office.
• Prepare and handle as needed per client, COI and NF10
• Assemble panel reports
• Send out Finalized reports to the clients.
• Follow up on NY PIP reports that are required to be notarized and were sent out to the client as Notary to Follow to avoid missing TAT.
• Ensures all federal ERISA and/or state mandates are adhered to at all times.
• Provides insight and direction to management on consultant quality, availability and compliance with all company policies and procedures and client specifications.
• Promote effective and efficient utilization of company resources.
• Participate in various educational and or training activities as required.
• Has an excellent command of grammar and medical terminology

• Meets specific department metrics
• Operates company software and equipment
• Enters data by inputting alphabetic and numeric information into system via keyboard
• Maintains confidentiality and discretion as a general rule
• Works effectively as a team contributor on all assignments
• Interacts professionally with other employees as well as clients
• Has a clear and concise understanding, and adheres to, guidelines as they relate to HIPAA, Conflict of Interest, and Ethics

Qualifications
Minimum Education: Associates degree
Required Skills and Experience: Typically requires a minimum 2-4 years of related experience. RN license is required.
Desired Skills and Experience: Prefer someone with background and knowledge in the Disability Insurance space and with FMLA/ADA.
Benefits
We're committed to supporting your ultimate well-being through our total compensation package offerings that support your health, wealth and self. These offerings include Medical, Dental, Vision, Health Savings Accounts / Flexible Spending Accounts, Life and AD&D Insurance, 401(k), Tuition Reimbursement, and an array of resources that encourage a lifetime of healthier living. Benefits eligibility may differ depending on full-time or part-time status. The Company is an equal opportunity employer. All qualified applicants will receive consideration for employment without regard to race, religion, color, national origin, gender, gender identity, sexual orientation, age, status as a protected veteran, among other things, or status as a qualified individual with disability. Don't meet every single requirement? Studies have shown that women and underrepresented minorities are less likely to apply to jobs unless they meet every single qualification. We are dedicated to building a diverse, inclusive, and authentic workplace, so if you're excited about this role but your past experience doesn't align perfectly with every qualification in the job description, we encourage you to apply anyway. You may be just the right candidate for this or other roles. #LI-EG1