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United States
Remote only
This position is listed on behalf of a partner company, who manages all applications and next steps. Our partner is looking for a Disability Claims QA Specialist based in the United States.
The Disability Claims QA Specialist will play a key role in ensuring the accuracy, completeness, and quality of medical reports supporting short-term and long-term disability claims. This role combines disability claims expertise, clinical documentation review, and quality assurance to help deliver reliable outcomes for clients. You will assess physician reports, verify that medical evidence supports clinical determinations, and ensure all relevant questions are addressed before cases are returned. Working closely with physician reviewers, their teams, and clients, you will help maintain high standards of accuracy while meeting strict service deadlines. You will also provide additional oversight for complex cases and identify issues requiring further review. This remote opportunity is suited to a detail-oriented professional who thrives in a fast-paced healthcare and insurance environment.
You will oversee the quality of disability claim documentation and physician reports, ensuring that each case is complete, accurate, and aligned with applicable client and jurisdictional requirements.
Review physician reports and accompanying medical records to ensure they meet client expectations and relevant standards for long-term disability claims.
Verify that the medical documentation and supporting evidence appropriately substantiate physicians’ determinations.
Interpret disability policy guidelines and healthcare terminology to assess whether the applicable criteria for long-term disability are met.
Work directly with clients on individual cases, providing responsive service and delivering complete, accurate, and timely quality assurance.
Communicate with physician reviewers and their teams to clarify information, address outstanding questions, and ensure reports respond to all requested points.
Manage and oversee complex long-term disability cases that require additional quality review before being returned to clients.
Provide an additional layer of quality assurance for cases presenting documentation or quality concerns, applying specialized disability claims knowledge.
Ensure all deliverables meet client deadlines while maintaining consistent accuracy and quality standards.
Participate in additional assignments and special projects as required by business needs.
Requirements
The ideal candidate has practical disability claims experience, strong analytical judgment, and the ability to review medical documentation with exceptional attention to detail. You should be comfortable managing competing priorities, communicating with different stakeholders, and maintaining high-quality standards in a deadline-driven remote environment.
Previous disability claims experience is required.
At least 5 years of claims experience is preferred.
Experience in healthcare, insurance, or a related business environment is an advantage.
An Associate’s or Bachelor’s degree is preferred.
Ability to interpret policy guidelines, understand healthcare terminology, and assess medical documentation in the context of disability claims.
Strong attention to detail and a consistent commitment to accuracy and completeness.
Excellent written and verbal communication skills, with the ability to communicate clearly and professionally with clients and physician reviewers.
Strong critical-thinking and problem-solving abilities, including the judgment to identify inconsistencies and determine when further review is necessary.
Effective time-management and organizational skills, with the ability to work independently, prioritize tasks, and meet strict deadlines.
A self-motivated and performance-driven approach, with a strong sense of urgency and accountability.
Proficiency in using computers and navigating multiple software applications; familiarity with Google Chrome, Gmail, Docs, and Sheets is an advantage.
Good typing skills and general computer literacy.
Ability to work remotely while maintaining a reliable, uninterrupted internet connection. Employees are responsible for supplying and supporting their own internet service.
Working Conditions
The role involves extended periods of sitting and working at a computer.
Candidates should be able to meet the physical demands associated with the responsibilities of the position, including any required lifting, bending, or travel.
Benefits
Competitive compensation based on experience, education, and relevant skills.
Comprehensive medical, dental, and vision insurance for employees and their families.
Voluntary life insurance options for employees, spouses, and children.
Additional voluntary coverage options, including hospital indemnity, critical illness, accident indemnity, and pet insurance.
Basic life insurance at no cost to employees.
Short-term and long-term disability coverage at no cost to employees.
Paid time off to support work-life balance and personal well-being.
401(k) retirement plan with company matching contributions.
Apple equipment provided for the remote workspace.
Media stipend to support remote work.
Performance bonuses.
Opportunities for professional development and career growth within a performance-oriented organization.
