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ExamWorks operates at the intersection of healthcare, consulting, and legal services, providing independent medical examinations and peer reviews for claims and related processes. Its work also includes bill reviews, Medicare compliance, medical-record and document management, and compliance auditing.
The company supports a broad physician network and develops enterprise platforms and workflow tools for healthcare organizations. Its teams combine clinical, operational, compliance, and technology expertise to help clients manage medical records and claims with greater consistency and reliability.
Remote Case Coordinator - California | ExamWorks
Support compliant, high-quality medical review reports for Advanced Medical Reviews. Coordinate peer reviewers, quality checks, client requirements, and regulatory compliance.
Description
- Review reports, correspondence, addenda, and supplemental reviews for quality assurance
- Confirm that recommendations and determinations are supported by clear, concise, evidence-based rationales
- Check that client instructions, specifications, and questions are fully addressed
- Validate that clinical citations and references are current and drawn from reputable medical journals or publications
- Ensure report content, formatting, and presentation meet company standards
- Confirm cases receive review by the appropriate board-certified specialty and are documented accurately
- Verify peer reviewer attestations and conflict-of-interest disclosures
- Confirm final reports include provider credentials and signatures
- Investigate report inconsistencies and contact peer reviewers for clarification or correction
- Support the resolution of customer complaints and quality assurance concerns
- Maintain compliance with federal ERISA requirements and state mandates
- Provide management with insight into consultant quality, availability, and compliance
- Help optimize the use of company resources
- Take part in educational and training programs
- Complete other assigned responsibilities
Requirements
- High school diploma or equivalent
- At least two years of clinical or related experience, or an equivalent combination of education and experience
- Knowledge of insurance operations, preferably claims management involving workers' compensation, no-fault, liability, or disability
- Strong understanding of medical terminology, anatomy and physiology, medications, and laboratory values
- Ability to calculate with whole numbers and decimals and determine rates and percentages
- Typing speed of at least 40 words per minute
- Ability to use computers, fax machines, copiers, scanners, and telephones
- Familiarity with Microsoft Word, Outlook, Excel, and the internet
- Excellent command of English usage, grammar, punctuation, and style
- Ability to follow instructions accurately and respond appropriately to senior management
- Ability to work independently, prioritize tasks, and manage time effectively
- Ability to protect confidential information
- Ability to remain focused during normal or heavy distractions
Benefits
- Medical insurance
- Vision insurance
- Dental insurance
- Paid time off
- 401(k) plan
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