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 • Role Conduct retrospective review of medical, surgical, and behavioral health claims. • Focus Evaluate claims for medical necessity, appropriateness, and adherence to program benefits. • Collaboration Work closely with medical directors, providers, peer reviewers, and various internal teams. Key Responsibilities • Review and validate claims using established criteria and processing guidelines. • Prepare cases for payment or further review. • Identify opportunities for process improvement and flag quality or fraud concerns. • Support peers and clinical/non-clinical staff with claims and coding inquiries. What You Bring • Required • High School Diploma or GED. • 2+ years of experience in medical claims review. • Familiarity with medical claims processing and terminology. • Preferred • Coding experience. • Knowledge of behavioral health claims. Skills for Success • Strong technical skills in claims tools (e.g., CDST, Supercoder). • Organizational and team-building abilities. • Resilience in a fast-paced, high-intensity environment. • Effective communication and problem-solving. Additional Requirements • Must pass background, credit, and drug screening. • 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! #Workwolf #BCDC_Consulting Apply To This Job