Quality Assurance Auditor 3
Mitchell, Genex and Coventry
With Mitchell, Genex and Coventry now one organization, we’ve dramatically expanded our ability to deliver innovative services and technologies to our customers. We’ve also seen career opportunities within our combined organization grow. Each part of our organization helps people recover after a challenging event in their lives.
Mitchell delivers trusted software and services to the property & casualty claims, collision repair and risk management industries with technology-enabled solutions that simplify claims handling, repair processes and pharmacy transactions. Genex helps injured workers return to their jobs in a safe and efficient manner through compassionate case management, reducing health care costs and disability expenses for our customers. Coventry offers the nation’s largest and most diverse set of provider and ancillary networks focused on improving total overall outcomes.
Together, we bring a complete set of proven capabilities for our partners who require more than one-dimensional solutions. We combine innovative technology, insightful analytics and deep expertise to help them reach their ultimate goal\u2014restoring lives.Job Description
The Quality Assurance Auditor conducts activities to support and direct Field Case Management operations staff to ensure Customer expectations and Best Practice standards are met. Responsible for conducting quality management, procedural documentation, and/or special analysis audits and projects. Conducts contractually required customer audits involving financial penalty. Work is performed independently within a structured environment. Receives support and guidance from management within the framework of policies and procedures and overall objectives.
Primary responsibilities include the following:
- Review and correct the work product (reports and billed activity) submitted by Field Case Managers.
- Partner with Operations to provide coaching and training of case managers related to best practice expectations and customer specific directives.
- Conduct audits that require objective and subjective analysis.
- RN and/or certification (CCM, CRC, CDMS)
- Prior work experience with workers’ compensation claims required.
- Knowledge of medical terminology.
- Previous quality management experience preferred.
- Effective communication skills, both verbal and written.
- Strong computer skills, including a thorough understanding of Microsoft Word as well as a proven ability to quickly learn in-house developed applications.