Quality Review Analyst (Workers' Compensation Auditor)
The Quality Review Analyst is responsible for analysis of claim staff work product to ensure accordance with MEMIC Claim Department claim handling philosophy, best practices, policies and procedures. The Quality Review Analyst will conduct periodic retrospective file quality reviews in accordance with MEMIC’s quality review plan. While carrying out these duties the Quality Review Analyst will complete quality review forms and summary reports to be shared with the Claim Management team on a regular basis for training, development and/or informational purposes.
- Completes claim file quality reviews on a retrospective basis in accordance with the MEMIC Claim Department quality review plan.
- Provides written documentation explaining whether individual claim staff work product meets MEMIC Claim Department claim handling philosophy, best practices, policies and procedures.
- Reviews and measures work product of third party claim administrators at regularly scheduled intervals.
- Assists with the development and updating of quality review sheets, quality review procedures, and jurisdictional specific procedure guides.
- Assists Claim Department management team members with the coordination and reconciliation of external claim quality reviews and data requests.
- Assists the department with training, mentoring and development of claims team.
- Acts as a resource for the claims compliance unit on an as needed basis.
- Requires a Bachelor’s Degree with a minimum of 3-5 years’ experience handling complex workers’ compensation claims or an equivalent combination education and experience.
- Must possess a sound working knowledge of workers' compensation claim handling philosophy, procedures, best practices and quality review standards.
- Must have an excellent understanding of the scope and application workers’ compensation laws for all states where MEMIC provides coverage.
- Must have excellent written and verbal communication skills.
- Must be organized and able to prioritize and focus while working with stakeholders across the MEMIC Group.