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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates expertise in quality assurance processes, ensuring compliance with federal ERISA and state mandates while maintaining high standards in report accuracy and professionalism. Proficient in medical terminology and claims management within the insurance industry, with strong organizational and communication skills.
Highest-signal resume keywords
Quality Assurance ReviewsMedical Terminology KnowledgeClaims Management ExperienceMicrosoft Office ProficiencyConfidentiality Maintenance
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Quality AssuranceMedical TerminologyArithmetic CalculationsTyping Speed (40 W.P.M.)Report Documentation
Soft Skills
Attention to DetailIndependent WorkTime ManagementEffective CommunicationProblem Solving
Tools & Technologies
Microsoft WordMicrosoft OutlookMicrosoft ExcelComputer OperationFax Machine
Industry Keywords
Insurance IndustryClaims ManagementWorkers CompensationNo-FaultDisability
About the role
Key responsibilities & impact- Perform quality assurance reviews of reports, correspondence, addendums, and supplemental reviews
- Ensure clear, concise, evidence-based rationales support recommendations and determinations
- Verify client instructions, specifications, and questions are addressed
- Confirm clinical citations and references are current and from reputable medical journals or publications
- Ensure report content, format, and professional appearance meet company standards
- Verify appropriate board specialty review and accurate documentation on case reports
- Verify peer reviewer attestations and absence of conflicts of interest
- Ensure provider credentials and signatures are included in final reports
- Identify report inconsistencies and contact Peer Reviewers for clarification or correction
- Assist with customer complaints and quality assurance issues
- Ensure compliance with federal ERISA and state mandates
- Provide management insight on consultant quality, availability, and compliance
- Promote effective utilization of company resources
- Participate in educational and training activities
- Perform other assigned duties
Requirements
What you’ll need- High school diploma or equivalent required
- A minimum of two years clinical or related field experience, or equivalent combination of education and experience
- Knowledge of the insurance industry, preferably claims management relative to workers compensation, no-fault, liability, and/or disability
- Strong knowledge of medical terminology, anatomy and physiology, medications and laboratory values
- Ability to perform arithmetic calculations with whole numbers and decimals and compute rates and percentages
- Qualified typist with a minimum of 40 W.P.M.
- Ability to operate a computer, fax, copier, scanner, and telephone
- Knowledge of Microsoft Word, Outlook, Excel, and the Internet
- Excellent English usage, grammar, punctuation, and style
- Ability to accurately follow instructions and respond to upper management
- Ability to work independently, prioritize work, and use time efficiently
- Ability to maintain confidentiality
- Ability to stay focused under normal or heavy distractions
Benefits
Comp & perks- Medical insurance
- Vision insurance
- Dental insurance
- Paid time off
- 401k