2 quality analyst jobs found in Folsom, CA

The Claims Training Specialist is responsible for developing curricula to ensure adherence to CorVel’s best practice guidelines, special customer handling requirements, improve quality of audit metrics and overall claims outcomes. This includes ensuring that a designated geographical claims area of CorVel is equipped with an Operations workforce that can optimize its current and future goals and objectives, and deliver quality services that can meet our clients’ requirements and service expectations.  In order to efficiently execute daily responsibilities, the Claims Training Specialist must first obtain a deep understanding of the business to articulate what our claims model does and to clearly demonstrate all aspects of the Operations roles in order to be able to successfully conduct and oversee the department training.   Other duties to be carried out by Claims Training Specialist will include conducting classroom, virtual, and field training to internal employees/colleagues,...

The Professional Review Nurse provides analysis of medical services to determine appropriateness of charges on multiple types of medical bills and review of medical reports to determine appropriateness of medical care.   This is a remote position in CA. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Identify the necessity of the review process and communicate any specific issues of concern to the claims examiner/client and/or direct reporting manager   Collect supporting data and analyze information to make decisions regarding appropriateness of billing, delivery of care and treatment plans Utilize clinical and/or technical expertise to address the provision of medical care and identify inappropriate billing practices and errors, such as: duplicate billing, unbundling of charges, services not rendered, mathematical and data entry errors, undocumented services, reusable instrumentation, unused services and supplies, unrelated and/or separated charges, quantity and time...