Workers' Compensation Bill Review Qa Analyst

Flexible Hybrid

This position can be filled filled in ANY Zenith Location with preference to Sarasota, FL, Woodland Hills and Orange, CA Branches

Under limited supervision, performs various quality assurance activities to validate and ensure accuracy and timely payments of medical bills in accordance with Workers' Compensation laws and associated state fee schedules as well as the accuracy and timeliness of claim document classification and routing. Reviews and analyzes data and metrics to identify trends as well as improvement, efficiency and training opportunities to name a few. Assist in the development and facilitation of various training programs with the Bill Review and EDS departments. The essential functions of this position include, but are not limited to, the following:

• Collect and analyze data samples of work from employees to determine overall quality as it relates to accuracy, timeliness, completeness, and adherence to guidelines.
• Communicate cumulative results to supervisor and employee, noting items of success and items that need correction.
• Compile, track, and aggregate audit results in order to identify trends, areas of improvement as well as training opportunities.
• Work with various systems, processes and procedures to QA work from the Bill Review and EDS departments.
• Identify root causes and process improvement opportunities and communicate them effectively with appropriate parties (via reports or presentations). Provide recommended corrective action and analysis as input to continuous process/quality improvement program.
• Provide recommendations for training opportunities based on QA analysis and develop training modules and programs to address key learning needs.
• Facilitate new hire, certification, process change, and when needed, training related to system conversion and updates (tactical use of system and strategic approach to bills).
• Apply principles of logical thinking to define problems, collect data, establish facts and draw valid conclusions.
• Responds positively to direction and critique of performance.
• Consistently maintain professional and appropriate demeanor.
• Other duties and projects as assigned.

Education Qualifications

• High School Diploma or equivalent combination of education and experience required
• Bachelor’s Degree or equivalent combination of education and experience preferred

Experience Qualifications

• 3+ Years medical Bill Review experience required

Skills and Abilities

• Ability to communicate proficiently using industry and regulatory language.,
• Knowledge of various claims documents and taxonomy helpful.,
• Proven ability to work independently, meet deadlines, and work effectively and collaboratively as a member of a team.,
• Minimum of 1 year training experience preferred.,
• Excellent writing and presentation skills.,
• Ability to analysis and problem solve.,
• Strong organizational skills.
• Demonstrated oral and written communication skills.
• A positive, energetic and enthusiastic personality with a keen appreciation for customer service.

The expected salary range for this position is $45,722.94 to $57,153.67. Actual pay will be adjusted based on experience, geographic location, and other job-related factors as permitted by law. 

Qualifications may warrant placement in a different job level.
All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability or veteran status. If you are a qualified individual with a disability or a disabled veteran, you have the right to request an accommodation if you are unable or limited in your ability to use or access our career center as a result of your disability. To request an accommodation, contact a Human Resources Representative at Zenith Insurance Company.