Quality Review Specialist

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The Opportunity

We're looking for a Quality Review Specialist, working in the Insurance industry in Albuquerque, New Mexico, United States.

  • Works closely with Customer Service and Internal Medical Directors to ensure appeal process meets established guidelines. 
  • Adheres to accreditation and regulatory requirements to improve customer service and achieve organizational goals related to complaint and appeal resolution. 
  • Manages individual inventory through appropriate workflow. 
Details

The pay range we are offering is 34 to 35 per hour. This position may present an opportunity to go permanent.

Our Client

Our client is a fast-growing industry-recognized staffing firm.  Recruiting critical IT, Financial, Engineering, Healthcare, and Data Analytics talent.  With 20+ years’ experience and growth. 

Connections in Automotive, Healthcare, Retail, Financial & Insurance, and Professional & Business Services.  Working to bring top talent together with premier organizations.

Big enough to have great opportunities.  Small enough to care about finding the right one for you. 

It’s about relationships based on mutual interest.  The results are low turnover, long-lasting partnerships and growth.  Want to work for a company invested in your success?

Experience Required for Your Success
  • Registered Nurse (RN) Bachelor Degree OR 4 years in health care experience
  • At least 5 years of claims and mainframe system experience
  • Experience in health operations
  • Experience with internal/external customer relations
  • Knowledge of managed care processes
  • Knowledge and familiarity of national accreditation standards, specifically NCQA and URAC standards
What Do You Think?

Does your experience reflect what it takes to be successful in this role? Do the work and challenges get you excited about what's possible? Apply here.

Not exactly? Join Our Talent Community, and we'll let you know of additional opportunities.

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