OVERVIEW
As a Quality Assurance Case Manager, you are responsible for reviewing Independent Medical Evaluation (IME) reports. In this position you will complete assigned tasks with proficient use of our systems and processes. The overall goal of this function is to verify the content of IME reports with the medical documentation available to ensure accuracy and consistency in addition to ensuring compliance with respect to the specific client Service Level Agreements (SLAs). The Quality Assurance Case Manager will make decisions that align with the company’s mission, purpose and values.
JOB RESPONSIBILTIES
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Help to execute department goals (i.e. time from receipt of report to 1st round of edits to the assessor)
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Understand all client SLAs; work closely with Team Lead, Quality Assurance and Manager, Quality Assurance, to ensure they are achieved
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Prioritize reports assigned on Expeflow (EF) and/or SmartSimple (SS) to meet reporting timelines and finalize all tasks in accordance with client SLA’s
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Verify report content with medical documentation on file to ensure consistency throughout. This includes spelling, grammar and formatting as per DFSI templates
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Identify any problems or inconsistencies within the report and speak with the Team Lead, Quality Assurance for assistance, if required
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Perform ‘End of Multi’ process on files when required and ensure consensus between assessors
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Ensure any suggested changes to the reports are sent to and approved by the assessors in writing
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Address and respond to assessor queries and/or correspondence in a timely manner; effectively resolve any issues
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Communicate effectively and confidently with all assessors with regards to suggested edits or clarifications to their report
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Coordinate with Team Lead, Quality Assurance when dealing with complex files and/or situations to determine the best course of action
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Upload final reports to client portal as required to meet client SLA’s
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Other duties as assigned
