Medical Benefit Review Services Associate

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

📋 Description

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

• Assess and update member eligibility.

• Investigate and communicate any questionable situations.

• Record findings from the client system in associated systems.

• Offer analytical support to CPIS overpayment initiatives.

• Access client claims systems for Medicare, Medicaid, and Commercial claim overpayments identified through audits.

• Communicate effectively with staff and team members.

• Work autonomously based on established procedures.

• Research insurance eligibility and medical claims.

• Produce accurate, high-quality work.

⛳️ Requirements

• Applicants must be 18 years or older.

• A high school diploma or GED is required.

• Must successfully complete a preemployment criminal background check and drug screening.

• Basic understanding of insurance procedures and experience working with insurance carriers, Medicare, and Medicaid is necessary.

• Experience in data entry and processing medical claims data is essential.

• Excellent verbal and written communication skills are a must.

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

• Familiarity with medical terminology and healthcare eligibility processes is important.

• Strong skills in investigation, research, and critical thinking are needed.

• Strong organizational and multitasking capabilities are essential.

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

• Must pass an internet speed test: download ≥25 Mbps, upload ≥5 Mbps, ping ≤175 ms.

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

• Candidates must reside in an eligible listed state.

• Availability to work Monday through Friday, from 8:00 AM to 4:30 PM EST is required.

🏝️ Benefits

• Fully remote position.

• Flexible Monday-Friday schedule.

• No weekends required.

• Competitive starting salary.

• Collaborative team environment.

• Eligibility for benefits starting on day 1.

• Health insurance coverage offered.

• Optional dental and vision programs available.

• Life and disability insurance provided.

• Retirement savings plan included.

• Paid holidays.

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

• Potential for bonuses or incentives based on business needs.