Medical Benefit Review Services Associate

This is a fully remote position, open to applicants in Alabama, +34 more states.

📋 Description

• Offer analytical assistance to CPIS overpayment initiatives by accessing client claims systems.

• Evaluate paid claims, adjusted claims, and offset claims within the client system.

• Assess and update member eligibility status.

• Investigate and address any questionable situations.

• Record findings from the client system in related databases.

• Communicate effectively with colleagues and team members.

• Operate independently following established protocols.

• Research insurance eligibility and medical claims.

• Recognize and handle overpayments for Medicare, Medicaid, and Commercial claims.

⛳️ Requirements

• Applicants must be 18 years or older.

• A high school diploma or GED is required.

• Candidates must successfully pass a pre-employment criminal background check and drug screening.

• Fundamental knowledge of insurance procedures, including interactions with insurance carriers, Medicare, and Medicaid.

• Experience in data entry and processing medical claims data.

• Strong verbal and written communication skills are essential.

• Proficiency in Microsoft Office (Word, Excel, and Outlook) is required.

• Familiarity with medical terminology and healthcare eligibility processes.

• Excellent investigative, research, and critical thinking abilities.

• Strong organizational and multitasking skills.

• Capability to work independently while effectively collaborating with a remote team.

• Must pass an internet speed test (download speed equal to or greater than 25 Mbps, upload speed equal to or greater than 5 Mbps, and ping less than or equal to 175 ms).

• Ability to connect to a modem/router via an ethernet cable is required.

• Applicants must reside in one of the designated eligible states.

• A background in benefit and coverage concepts is preferred.

🏝️ Benefits

• Fully remote work opportunity.

• Flexible schedule available Monday through Friday.

• No weekend work required.

• Competitive starting salary.

• Team-oriented collaborative environment.

• Benefits eligibility begins on day one.

• Health insurance coverage provided.

• Options for voluntary dental and vision programs.

• Life and disability insurance available.

• Retirement savings plan included.

• Paid holidays offered.

• Paid time off (PTO) or vacation and/or sick time provided.

• Potential eligibility for bonuses or incentives.