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:
- Team player with demonstrated ability to work in a highly collaborative environment
- Good organizational and time-management skills
- Analytical Skills
- Decision-making and multi-tasking capabilities
- Strong verbal and written communication skills
- Knowledge of MS Office, including Word and Excel
Preferred Qualifications:
- Bill processing experience preferred
Compensation: Salary is commensurate with experience and credentials.
Pay Range: $47,816-$55,523Eligible 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.
NJM Insurance Group Compensation & Benefits Highlights
The following summarizes recurring compensation and benefits themes identified from responses generated by popular LLMs to common candidate questions about NJM Insurance Group and has not been reviewed or approved by NJM Insurance Group.
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Retirement Support — Retirement benefits include a 401(k) match with additional company contributions, materially boosting total compensation. This component is presented as a core element of the total rewards offering.
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Healthcare Strength — Health coverage offers multiple medical plan options plus dental and vision, complemented by company-paid basic life insurance and disability protection. Wellness resources and assistance programs further support overall health needs.
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Leave & Time Off Breadth — Time off includes a first-year PTO allotment paired with paid/floating holidays and state-based paid sick leave. Paid parental leave references and adoption assistance indicate breadth for various family situations.
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What We Do
NJM is among the Mid-Atlantic's leading property and casualty insurers. Founded in 1913, NJM's mission is to provide value-based insurance solutions to its policyholders with the highest levels of service, integrity, and financial stewardship. The Company operates in a mutual fashion for the exclusive benefit of its policyholders. Headquartered in West Trenton, NJ, with offices in Hammonton and Parsippany, NJM employs nearly 2,500 workers. - 2019-2023 Forbes Best In-state Employer (Ranked #11 out of 89 NJ employers in 2023) - 2018, 2019, 2020, 2021, certified by J.D. Power for providing "An Outstanding Auto Claims Experience" for personal lines customers* - 2018, 2019, & 2020 Clearsurance Customers’ Choice Top Ranked Insurance Companies - 2021 American Heart Association Gold Level Workplace Health Achievement - 2020 American Heart Association Silver Level Workplace Health Achievement - 2019 Forbes Best Mid-size Employers in the country *J.D. Power Auto Claims Certification Program℠ recognition is based on successful completion of an audit, exceeding a customer experience benchmark through a survey of recent claims servicing interactions, and a Financial Strength rating. For more information, visit jdpower.com.
