Quality Assurance Specialist
Summary
Quality Assurance Specialist at MEMIC, a workers' compensation insurer, monitors and reviews indemnity claim files to ensure compliance with internal best practices and state statutory requirements, analyzes trends, and supports compliance and training staff. Based in Portland, Maine; requires 2-4 years of claim handling experience.
The Quality Assurance Specialist’s primary responsibility is to monitor and review claims to ensure compliance with MEMIC’s internal best practices, as well as statutory requirements, and to develop and implement strategies to improve compliance in these areas. In addition, this position may be called upon to assist and support the compliance and training staff in the development of compliance plans and training documentation.
Responsibilities:
- Monitors indemnity claim file activity in real time to ensure jurisdictional benchmarks related to timeliness of initial compensability determinations, accuracy of payments and/or denials, and completion of forms over the life of the claim are met.
- Reviews state specific legal orders to ensure timely response, payment and form filings, when applicable.
- Reconciles penalties incurred to confirm validity and provides recommendations to Claim Management on the appropriateness of a payment or an appeal, when applicable.Identifies, analyzes, and summarizes trends in results and works with Claim Management and/or Claim Trainers to develop a plan to enhance quality and performance.
- Completes objections of fee reviews in applicable jurisdictions, follows for and tracks response.
- Completes state reconciliation in applicable jurisdictions.Retroactively reviews selected indemnity claim files from a compliance perspective and summarizes results by utilizing structured review sheets to objectively demonstrate claim handler’s performance.
- Assists Compliance Associate with mandatory Medicare reporting data integrity as needed.
- Assists with quality reviews of Compliance Assistants as needed.
- Supports compliance team goals by assisting with special projects or tasks as directed by Manager, Claim Compliance.
Requirements
- Bachelors Degree is preferred.
- 2-4 years of claim handling experience required; multi-jurisdictional experience preferred, workers compensation experience preferred.
- Strong attention to detail, accuracy, and analytical skills are necessary.
- Excellent interpersonal, written and verbal communication skills are essential.
- Must be organized with effective time management skills to meet strict deadlines, when necessary.
- Must have ability to prioritize and focus.
- Must possess the ability to work effectively in a fluid team environment and self-motivate.
- Proficient in Microsoft Office.
MEMIC is committed to a policy of nondiscrimination and equal opportunity for all employees and qualified applicants without regard to race, color, religious creed, national origin, ancestry, age, disability, genetics, gender identity, veteran's status, sexual orientation, or any other characteristic protected by law. Additionally, we are committed to providing an inclusive and accessible recruitment experience for all candidates. If you need a reasonable accommodation during the interview process, please contact us at hr@memic.com.
To ensure an equitable and authentic interview process, candidates should not use AI or chatbot tools during the live interview or phone screen. We welcome any preparation you choose to do beforehand, but all responses shared during the interview must be your own.
Note: MEMIC does not offer Stem-OPT EAD Extension for this role.
MEMIC's Job Applicant Privacy Notice
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As published by greenhouse · 12 questions
Basics
First Name, Last Name, Email, Phone, Resume/CV, Cover Letter, Location
Short answers (2)
- 12. Have you ever been employed here before? If so, what dates?
- 13. I hereby certify that the information contained in the employment application I submit to Maine Employers’ Mutual Insurance Company, hereinafter referred to as (“MEMIC”) or (“the Company”) is true and complete to the best of my knowledge. I understand that material omissions or falsification of this application may result in my disqualification from consideration for employment or dismissal from employment. I understand that the information I provide will be processed in accordance with MEMIC’s Job Applicant Privacy Notice (https://www.memic.com/job-applicant-privacy-notice). understand that my employment is subject to a satisfactory check of references. I authorize MEMIC and/or its designees the right to investigate the information given and to secure additional information, if necessary. I authorize my previous employers, educational institutions and all other individuals and organizations listed in this application form to provide information about my employment, work habits and character. I agree that MEMIC, and/or its designees and my previous employers, educational institutions and all other individuals and organizations listed in this application form will not be held liable in any respect if an employment offer is not made, is withdrawn, or my employment is terminated because of furnishing necessary information incident to the employment process. I understand that MEMIC is in no way obligated to provide employment and I am in no way obligated to accept employment, if offered. This application does not bind either party, and the statements contained herein do not constitute and should not be interpreted to constitute any sort of contract of employment for a specific period of time. I understand this application for employment is valid for 30 days only. Consideration for employment after 30 days requires a new application. I understand that upon offer and acceptance of a position with MEMIC, I will be required to provide documentation establishing my identity and eligibility to be legally employed in the United States. I understand that employment at MEMIC is employment at will. Employment may be terminated with or without cause at any time by me or by the Company. Terms and conditions of employment with MEMIC may be modified at the sole discretion of the Company with or without cause and with or without notice, except as may be required by law. I also understand that other than the President of the Company, no one has the authority to make any agreement for employment other than for employment at will or to make any agreement limiting the Company’s discretion to modify terms and conditions of employment. MEMIC is an equal opportunity employer, considering all qualified applicants and employees for hiring, placement, and advancement, without regard to a person’s race, national origin, color, religion, age, gender, sexual orientation, gender identity or expression, disability, genetic information, military and veteran status, or any other protected status under applicable federal, state or local law. If you agree to the above, please type your first and last name and today's date.
Pick from a list (10)
- 1. Are you legally eligible for employment in this country?
- 2. Will you require MEMIC immigration sponsorship now (for example H-1B sponsorship, Form I-983 training plan, etc.)?
- 3. Will you require MEMIC immigration sponsorship in the future?
- 4. What is your desired annual salary? If your desired compensation falls between ranges, please multi select.
- 5. If you are under 18, can you furnish a work permit?
- 6. What is the highest level of education you have completed?
- 7. What state do you reside in?
- 8. Will you relocate if the job requires it?
- 10. Are you able to perform the "essential functions" of the job for which you are applying (with or without reasonable accommodation)?
- 11. Have you entered into an agreement with any former employer or other party (such as a noncompetition agreement) that might, in any way, restrict your ability to work for our company?