Quality Control and Compliance Associate

NJM Insurance Group

64d • $47,816 - $55,523

About The Position

Reporting to the QC Supervisor, the Quality Control & Compliance Associate is responsible and accountable for conducting complete and thorough reviews of medical bills and participating in targeted compliance and process audits to support the department. This role also supports the QC Supervisor in completing compliance checklist reviews for both PIP and Workers’ Compensation Claims.

Requirements

• Team player with demonstrated ability to work in a highly collaborative environment.
• Good organizational and time-management skills.
• Analytical Skills.
• Decision-making and multi-tasking capabilities.
• Strong verbal and written communication skills.
• Knowledge of MS Office, including Word and Excel.

Nice To Haves

• Bill processing experience preferred.

Responsibilities

• Assist the QC Supervisor in completing PIP and WC compliance checklist reviews.
• Gather exhibits required, identify items needing sign off from other departments, and assist with compiling regulations for sign off.
• Establish audit parameters/thresholds, gather and compile data for closed claim and process audits for all identified business units as specified by Department Supervisor.
• Prepare target audit samples using SAS EG, Excel, and/or other tools.
• Collect and report audit findings.
• Consolidate data into report for supervisor review.
• Identify trends or patterns.
• Perform pre- and post-payment audits on WC and PIP medical payment in accordance with established procedures.
• Accurately maintain and document audit findings.
• Identify trends or patterns in errors for supervisor.
• Perform ad hoc tasks assigned by the Supervisor and/or Management.

Benefits

• 401(k) with employer match up to 8% and additional service-based contributions.
• Health, Dental, and Vision insurance.
• Life and Disability coverage.
• Generous PTO.
• Paid Sick Leave.
• Paid parental leave in addition to state-mandated leave.
• Eligibility for discretionary bonuses.

What This Job Offers

• Number of Employees: 1,001-5,000 employees