Role Description

Are you experienced in various types of medical benefits and services? We're looking for a detail-oriented healthcare professional who enjoys solving complex insurance billing and coverage issues and working in a fast-paced remote environment.

The Medical Benefit Review Services Associate II is responsible for providing analytical support to CPIS overpayment programs via access to the client claims systems related to Medicare, Medicaid, and Commercial claim overpayments identified through various audits.

If you have strong analytical skills, enjoy researching insurance eligibility and medical claims, and take pride in delivering accurate, high-quality work, we'd love to hear from you.

Key Responsibilities:

• Review of paid claims, adjusted claims, and offset claims in the client system.
• Review of member eligibility, update of member eligibility.
• Investigates and communicates questionable situations.
• Documents findings from the client system in the related systems.
• Communicate effectively with other staff/team members.
• Works independently based on established procedures.

Qualifications

• Must be 18 or older to apply.
• Must have a high school diploma or GED.
• Must be able to successfully pass a preemployment criminal background check and drug screening.
• Background in benefit/coverage concepts desired.
• Basic knowledge of insurance procedures, working with insurance carriers, Medicare, and Medicaid.
• Experience with data entry / medical claims data entry processing.
• Professional verbal and written communication skills required.
• Proficiency with Microsoft Office (Word, Excel, and Outlook).
• Understanding of medical terminology and healthcare eligibility processes.
• Strong investigative, research, and critical thinking skills.
• Excellent verbal and written communication skills.
• Strong organizational and multitasking abilities.
• Ability to work independently while collaborating effectively with a remote team.

Requirements

• Must pass an internet speed test (download equal to or greater than 25, upload equal to or greater than 5, Ping ms equal to or less than 175).
• Must have the ability to connect with an ethernet cable to a modem/router.
• Live in one of the following states: AL, AR, AZ, CO, CT, DE, FL, GA, ID, IN, IA, KS, KY, LA, ME, MI, MS, MO, NE, NV, NH, NJ, NM, NC, OH, OK, PA, RI, SC, SD, TN, TX, UT, VT, VA, WA, WV, WI, WY.
• We are currently NOT hiring in the following geographies, included but not limited to: States: AK, CA, CT, HI, MA, IL, MT & NY; Metro Areas: MN – Minneapolis, IL – Chicago, NY – New York City, OR - Portland, MD - Montgomery County, WA - Seattle, Washington, DC.

Benefits

• Fully remote position.
• Flexible Monday-Friday schedule.
• No weekends required.
• Competitive starting pay.
• Collaborative team environment.
• Eligible for benefits day 1.