Claims Reviewer
Claims Reviewer Opportunity
Join a dynamic team where your expertise in claims review can make a real difference! We're looking for a detail-oriented Claims Reviewer who can apply clinical and coding knowledge to ensure accurate claims processing. If you have a strong foundation in medical claims and are passionate about quality, we want to hear from you!
Position Highlights
ā¢ Role: Conduct retrospective review of medical, surgical, and behavioral health claims.
ā¢ Focus: Evaluate claims for medical necessity, appropriateness, and adherence to program benefits.
ā¢ Collaboration: Work closely with medical directors, providers, peer reviewers, and various internal teams.
Key Responsibilities
ā¢ Review and validate claims using established criteria and processing guidelines.
ā¢ Prepare cases for payment or further review.
ā¢ Identify opportunities for process improvement and flag quality or fraud concerns.
ā¢ Support peers and clinical/non-clinical staff with claims and coding inquiries.
What You Bring
ā¢ Required:
ā¢ High School Diploma or GED.
ā¢ 2+ years of experience in medical claims review.
ā¢ Familiarity with medical claims processing and terminology.
ā¢ Preferred:
ā¢ Coding experience.
ā¢ Knowledge of behavioral health claims.
Skills for Success
ā¢ Strong technical skills in claims tools (e.g., CDST, Supercoder).
ā¢ Organizational and team-building abilities.
ā¢ Resilience in a fast-paced, high-intensity environment.
ā¢ Effective communication and problem-solving.
Additional Requirements
ā¢ Must pass background, credit, and drug screening.
ā¢ Adherence to federal THC policies (medical card required if applicable).
Eligible Locations
The position is remote, but you can only reside in the following states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY.
Ready to bring your claims expertise to a rewarding role? Apply today to be part of our team!
Apply Now
Join a dynamic team where your expertise in claims review can make a real difference! We're looking for a detail-oriented Claims Reviewer who can apply clinical and coding knowledge to ensure accurate claims processing. If you have a strong foundation in medical claims and are passionate about quality, we want to hear from you!
Position Highlights
ā¢ Role: Conduct retrospective review of medical, surgical, and behavioral health claims.
ā¢ Focus: Evaluate claims for medical necessity, appropriateness, and adherence to program benefits.
ā¢ Collaboration: Work closely with medical directors, providers, peer reviewers, and various internal teams.
Key Responsibilities
ā¢ Review and validate claims using established criteria and processing guidelines.
ā¢ Prepare cases for payment or further review.
ā¢ Identify opportunities for process improvement and flag quality or fraud concerns.
ā¢ Support peers and clinical/non-clinical staff with claims and coding inquiries.
What You Bring
ā¢ Required:
ā¢ High School Diploma or GED.
ā¢ 2+ years of experience in medical claims review.
ā¢ Familiarity with medical claims processing and terminology.
ā¢ Preferred:
ā¢ Coding experience.
ā¢ Knowledge of behavioral health claims.
Skills for Success
ā¢ Strong technical skills in claims tools (e.g., CDST, Supercoder).
ā¢ Organizational and team-building abilities.
ā¢ Resilience in a fast-paced, high-intensity environment.
ā¢ Effective communication and problem-solving.
Additional Requirements
ā¢ Must pass background, credit, and drug screening.
ā¢ Adherence to federal THC policies (medical card required if applicable).
Eligible Locations
The position is remote, but you can only reside in the following states: AK, AR, AZ, CO, DC, FL, HI, IA, ID, IL, KS, LA, MD, MN, MO, MT, NC, ND, NE, NM, NV, OK, OR, SC, SD, TN, TX, UT, VA, WA, WI, WY.
Ready to bring your claims expertise to a rewarding role? Apply today to be part of our team!
Apply Now