QA Medical Analyst

Company Description

We help the world see new possibilities and inspire change for better tomorrows. Our analytic solutions bridge content, data, and analytics to help business, people, and society become stronger, more resilient, and sustainable.

Job Description

About the Role

The QA Medical Analyst (MSA) for the Quality and Training Department will report to the Lead QA Medical Analyst and will be responsible for quality services related to the clinical staff and clinical components of our Medicare Set Aside (MSA) services/product line. This is a fast pace department with time-sensitive duties that include training new and current staff, product QA and Subject Matter Expert (SME) reviews. If you thrive in a fast-paced environment that emphasizes individual accountability with the support of a team structure, come join us!

About the Day to Day Responsibilities of the Role

• Perform case QA on files prepared by Medical Analysts and report via Crosspoint tracking
• Provide individual and manager feedback regarding QA results
• Provide user input regarding effectiveness of the QA tool and assist with QA tool updates
• Promote and support quality work, production and a positive attitude
• Provide file-specific cost mitigation strategies
• Strive to meet and exceed client quality expectations and meet deadlines and SLA’s
•  Respond to requests to MSA QA for case specific clinical and procedural guidance from various Services Department members
• Assist with analyzing and reporting of CMS approval trends
• Provide training and file SME review for new Medical Analysts using current training program
• Assist in maintenance and updates to the Projection Guidelines consistent with client specific protocols, CMS trends and product line expectations   
• Assist with creation, maintenance and updates to tools for Medical Analysts use in daily work in products/services
• Maintain knowledge in technology systems that impact the day to day work
• Act as a resource in education and consulting with staff on systems, as well as working with system designers on future enhancements
• Assist in MSA production (as a Medical Analyst) as requested by management
• Additional department duties and programs as implemented

Qualifications

About You and How You Can Excel in This Role

• Associate degree, bachelor’s degree or master’s degree in nursing
• Unrestricted license to practice nursing in at least one US state or territory
• Working knowledge of Medicare Secondary Payer (MSP) Statute 
• Medicare Set-aside Certified Consultant (MSCC) required
• Certification in Lifecare Planning or Case Management a plus
• At least 3 years’ experience in preparing or reviewing Medicare Set-Asides
• QA experience a plus
• Excellent interpersonal, communications, public speaking, and presentation skills
• Strong time management skills
• Management / leadership skills with a history of training
• Works well in team driven environment
• Excellent technical skills and working knowledge of Microsoft Office
• Able to work independently, self-directed, highly motivated
• Desire to work in a fast-paced, professional environment

Additional Information

In 2022, Verisk received Great Place to Work® Certification for our outstanding workplace culture for the sixth year in a row and second-time certification in the UK, Spain, and India. We’re also one of the 38 companies on the UK’s Best Workplaces™ list and one of 18 companies on Spain’s Best Workplaces™ list.

For over fifty years and through innovation, interpretation, and professional insight, Verisk has replaced uncertainty with precision to unlock opportunities that deliver significant and demonstrable impact. From our historic roots in risk assessment, we’ve grown to provide analytic insights that help transform industries focused on some of the world’s most critical areas. Today, the insurance industry relies on Verisk to be, and to make the world, more productive, resilient, and sustainable.

Verisk works in collaboration with our customers and at the intersection of people, data, and advanced technologies. Through proprietary platformed analytics, advanced modeling, and interpretation, we deliver immediate and sustained value to our customers and through them, to the individuals and societies they serve, with greater speed, precision, and scale.

We’re 9,000 people strong, committed to translating big data into big ideas. We help others see new possibilities and empower certainty into big decisions that impact individuals and societies. And we relentlessly and ethically pursue innovation to help move our customers, and the world, toward better tomorrows.

Everyone at Verisk—fr