Reporting to the Medical Services QC Supervisor in our West Trenton, New Jersey corporate office, the QC & 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 MSA QC Supervisor in completing compliance checklist reviews for both PIP and Workers’ Compensation Claims. This is a hybrid position that requires at least three days a week in the office.
Job Responsibilities
Assist the MSA QC Supervisor in completing PIP and WC compliance checklist reviews
Gather exhibits required, identify items needing sign off from other departments outside of MSA, 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 MSA 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 MSA Management
Required Skills & Qualifications
High School diploma or GED required, bachelor's degree preferred
2+ years proficient experience in using Microsoft, Excel and PowerPoint
Knowledge of the following systems a plus: Decision Point, Agile Point, Claim Center and Onbase
Team player with demonstrated ability to work in a highly collaborative environment
Good analytical, organizational and time-management skills
Decision-making and multi-tasking capabilities
Strong verbal and written communication skills
Legal Disclaimer: NJM is proud to be an equal opportunity employer. We are committed to attracting, retaining and promoting a diverse and inclusive workforce that is fully representative of the diversity that exists in the communities in which we do business.
Seniority level
Entry level
Employment type
Full-time
Job function
Research, Analyst, and Information Technology
Industries
Insurance
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