Quality Assurance Specialist III

The Quality Assurance Specialist plays a critical role in ensuring the accuracy, quality, and defensibility of independent medical examination (IME), peer review, and medical record review reports. This position requires a detail-oriented professional with experience in medical, claims, insurance, case management, utilization review, quality assurance, or related healthcare fields. The ideal candidate possesses strong medical terminology knowledge, critical thinking skills, and the ability to independently evaluate reports for consistency, completeness, causation analysis, and compliance with client and regulatory requirements. CorVel is a trusted leader in delivering innovative healthcare solutions. Our IME division provides independent medical examinations, peer reviews, medical record reviews, document management, and related services to insurance carriers, self-insured employers, third-party administrators, law firms, and government agencies nationwide. ESSENTIAL FUNCTIONS & RESPONSIBILITIES: Conduct comprehensive quality assurance reviews of IME, peer review, medical record review, addendum, and supplemental reports Review reports for grammar, spelling, punctuation, formatting, medical terminology, and professional presentation Evaluate reports for overall clinical consistency, completeness, and defensibility Verify all client questions, referral issues, and case-specific instructions have been fully addressed Identify inconsistencies, unsupported conclusions, contradictory opinions, missing documentation, or gaps in medical reasoning Analyze causation opinions and ensure conclusions are supported by the medical evidence documented within the report Collaborate directly with physicians and consultants to obtain report clarifications, corrections, or additional information when necessary Ensure compliance with client specifications, company standards, state mandates, and applicable federal requirements Verify provider credentials, board certifications, signatures, attestations, and conflict-of-interest statements as required Confirm appropriate citations, references, and evidence-based support are included when applicable Review reports for legal defensibility and consistency with referral documentation and medical records Assist in investigating, documenting, and resolving quality concerns, complaints, report rebuttals, and client escalations Participate in provider performance monitoring and communicate trends, concerns, and recommendations to management Identify opportunities for workflow improvement, quality enhancement, and operational efficiencies Support onboarding, training, and mentoring initiatives for new team members Maintain productivity and turnaround standards while ensuring a high degree of accuracy Participate in educational and training activities as required Maintain HIPAA compliance in all aspects of communications Additional duties as assigned KNOWLEDGE & SKILLS: Strong understanding of medical terminology, anatomy and physiology, disease processes, medications, diagnostic testing, and treatment guidelines Ability to independently evaluate medical reports and identify inconsistencies, unsupported conclusions, missing information, or causation-related concerns Demonstrated critical thinking and analytical skills with the ability to assess reports beyond grammar and formatting Excellent command of English language skills, including grammar, punctuation, and style Strong written and verbal communication skills Proficiency in Microsoft Word, Outlook, Excel, and web-based applications Ability to work independently, manage competing priorities, and meet deadlines Strong organizational skills with exceptional attention to detail Ability to maintain confidentiality and exercise sound judgment Comfortable working in a fast-paced environment with changing priorities and deadlines Working knowledge of workers' compensation, auto liability, no-fault, disability, or related insurance programs preferred Experience reviewing complex medical, legal, insurance, or claims-related documentation preferred EDUCATION & EXPERIENCE: High school diploma or equivalent required Associate's or Bachelor\'s degree in healthcare administration, nursing, medical assisting, claims management, legal studies, or a related field preferred, OR minimum five years of experience in one or more of the following: Independent Medical Examination (IME) Peer Review Medical Records Review Utilization Review Claims Management Case Management Medical Office Operations Quality Assurance Insurance Operations PAY RANGE: CorVel uses a market based approach to pay and our salary ranges may vary depending on your location. Pay rates are established taking into account the following factors: federal, state, and local minimum wage requirements, the geographic location differential, job-related skills, experience, qualifications, internal employee equity, and market conditions. Our ranges may be modified at any time. For leveled roles (I, II, III, Senior, Lead, etc.) new hires may be slotted into a different level, either up or down, based on assessment during interview process taking into consideration experience, qualifications, and overall fit for the role. The level may impact the salary range and these adjustments would be clarified during the offer process. In general, our opportunities will be posted for up to 1 year from date of posting, or until we have selected candidate(s) to fulfill the opening, whichever comes first. ABOUT CORVEL CorVel, a certified Great Place to Work® Company, is a national provider of industry-leading risk management solutions for the workers’ compensation, auto, health and disability management industries. CorVel was founded in 1987 and has been publicly traded on the NASDAQ stock exchange since 1991. Our continual investment in human capital and technology enable us to deliver the most innovative and integrated solutions to our clients. We are a stable and growing company with a strong, supportive culture and plenty of career advancement opportunities. Over 4,000 people working across the United States embrace our core values of Accountability, Commitment, Excellence, Integrity and Teamwork (ACE-IT!). A comprehensive benefits package is available for full-time regular employees and includes Medical (HDHP) w/Pharmacy, Dental, Vision, Long Term Disability, Health Savings Account, Flexible Spending Account Options, Life Insurance, Accident Insurance, Critical Illness Insurance, Pre-paid Legal Insurance, Parking and Transit FSA accounts, 401K, ROTH 401K, and paid time off. CorVel is an Equal Opportunity Employer, drug free workplace, and complies with ADA regulations as applicable. #LI-Hybrid Equal Opportunity Employer This employer is required to notify all applicants of their rights pursuant to federal employment laws.For further information, please review the Know Your Rights notice from the Department of Labor. #J-18808-Ljbffr