Quality Control and Compliance Associate

Quality Control & Compliance Associate

Reporting to the QC Supervisor, the Quality Control & 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. This role also supports the QC Supervisor in completing compliance checklist reviews for both PIP and Workers' Compensation Claims.

Essential Duties and Responsibilities :

• Assist the QC Supervisor in completing PIP and WC compliance checklist reviews.
• Gather exhibits required, identify items needing sign off from other departments, and assist with compiling regulations for sign off.
• Establish audit parameters / thresholds, gather and compile data for closed claim and process audits for all identified business units as specified by Department Supervisor.
• Prepare target audit samples using SAS EG, Excel, and / or other tools.
• Collect and report audit findings.
• Consolidate data into report for supervisor review.
• Identify trends or patterns.
• 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.
• Perform ad hoc tasks assigned by the Supervisor and / or Management.

Required Qualifications :

Preferred Qualifications :

Compensation : Salary is commensurate with experience and credentials. Pay Range : $47,816-$55,523 Eligible full-time employees receive a competitive Total Rewards package, including but not limited to a 401(k) with employer match up to 8% and additional service-based contributions, Health, Dental, and Vision insurance, Life and Disability coverage, generous PTO, Paid Sick Leave, and paid parental leave in addition to state-mandated leave. Employees may also be eligible for discretionary bonuses.

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.