Quality Control and Compliance Associate

<strong>Personal, compassionate service is what we&rsquo;re known for at NJM. We seek the best and brightest to help our customers when they need us most. As part of the NJM team, you'll not only enjoy some of the best benefits in the industry, you'll also be joining a company that's committed to professional development, diversity and innovative thinking.</strong><br /><br /><strong>What is it like to work at NJM?&nbsp; Click <a href="https://www.youtube.com/watch?v=6XVn3U0XK-0&amp;feature=emb_logo" target="_blank" title="Video" rel="noopener noreferrer">here</a> to see!<br /><br />If you don't see the position you are looking for, apply <a href="https://njm.wd1.myworkdayjobs.com/en-US/njm/introduceYourself" target="_blank" title="Introduce Yourself" rel="noopener noreferrer">here</a>.<br /></strong>


NJM Insurance

<p><strong>This isn&rsquo;t just insurance.&nbsp; It&rsquo;s NJM.</strong></p> <p>When you join the NJM family, you&rsquo;ll work with talented people who care about doing the right thing by our policyholders as well as each other. You&rsquo;ll be part of a financially strong and stable company that has flourished on relationships, integrity and service for more than a century. NJM is a special place where you can propel your career, help others and make friends &ndash; all at the same time.&nbsp;</p> <p>NJM is proud to offer our employees continuous learning options, outstanding benefits, access to wellness programs, and a wide range of opportunities to give back to the communities we are privileged to serve.&nbsp;</p> <p>Leading, independent consumer publications repeatedly recognize our commitment to customer and claims satisfaction. In addition, NJM has been named to the Forbes list of the Best Employers in New Jersey three years in a row, based on feedback directly from our employees.</p> https://www.njm.com/about/careers

keywords: position summary,audit,assist,performance,education & experience,skills

Full time

Overview: <p>​Reporting to the Medical Services QC Supervisor in our West Trenton, New Jersey corporate office, the QC &amp; 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. &nbsp;</p> <p>This role also supports the MSA QC Supervisor in completing compliance checklist reviews for both PIP and Workers&rsquo; Compensation Claims. This is a hybrid position that requires at least three days a week in the office.</p>
Responsibilities: <ul> <li>Assist the MSA QC Supervisor in completing PIP and WC compliance checklist reviews.</li> <li>Gather exhibits required, identify items needing sign-off from other departments outside of MSA, and assist with compiling regulations for sign-off.</li> <li>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.</li> <li>Prepare target audit samples using SAS EG, Excel, and/or other tools.</li> <li>Collect and report audit findings.</li> <li>Consolidate data into report for supervisor review.</li> <li>Identify trends or patterns.</li> <li>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.</li> <li>Perform ad hoc tasks assigned by the Supervisor and/or MSA Management.</li> </ul>
Requirements: <ul> <li>High School diploma or GED required, Bachelor's degree preferred.</li> <li>2+ years' proficient experience in using Microsoft, Excel and PowerPoint.</li> <li>Knowledge of the following systems a plus: Decision Point, Agile Point, Claim Center and Onbase.</li> <li>Team player with demonstrated ability to work in a highly collaborative environment.</li> <li>Good analytical, organizational and time-management skills.</li> <li>Decision-making and multi-tasking capabilities.</li> <li>Strong verbal and written communication skills.</li> </ul> <p>&nbsp;</p> <p>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.</p>