Medical Benefit Review Services Associate
About The Position
The Medical Benefit Review Services Associate II provides analytical support to CPIS overpayment programs by accessing client claims systems and reviewing Medicare, Medicaid, and commercial claim overpayments identified through audits. The role focuses on researching insurance eligibility and medical claims, resolving coverage and billing issues, and documenting accurate findings in related systems. The associate works independently using established procedures while collaborating with a remote team in a fast-paced environment. This is a fully remote position with a Monday-Friday schedule from 8:00 AM to 4:30 PM EST. The position requires an eligible residence state, an internet connection meeting specified speed and ping requirements, and the ability to connect to a modem or router by Ethernet. Starting pay is $18.00 per hour based on experience; the estimated annual salary range is $34,320-$42,900. Employees are eligible for benefits starting on day one.
Requirements
- Must be at least 18 years old.
- High school diploma or GED required.
- Must successfully pass a preemployment criminal background check and drug screening.
- Basic knowledge of insurance procedures and experience working with insurance carriers, Medicare, and Medicaid.
- Experience with data entry or medical claims data-entry processing.
- Professional verbal and written communication skills.
- Proficiency with Microsoft Word, Excel, and Outlook.
- Understanding of medical terminology and healthcare eligibility processes.
- Strong investigative, research, and critical-thinking skills.
- Strong organizational and multitasking abilities.
- Ability to work independently while collaborating effectively with a remote team.
- Must pass an internet speed test: download at least 25, upload at least 5, and ping no greater than 175 ms.
- Must be able to connect to a modem or router with an Ethernet cable.
- Must reside in an eligible state listed in the posting; hiring is restricted in certain states and metropolitan areas.
Nice To Haves
- Background in benefit and coverage concepts.
- Experience in medical benefits, insurance verification, medical billing, or healthcare claims.
Responsibilities
- Review paid, adjusted, and offset claims in the client system.
- Review and update member eligibility.
- Investigate and communicate questionable situations.
- Document findings from the client system in related systems.
- Communicate effectively with other staff and team members.
- Work independently based on established procedures.
Benefits
- Health insurance coverage
- Voluntary dental and vision programs
- Life and disability insurance
- Retirement savings plan
- Paid holidays
- Paid time off (PTO), vacation, and/or sick time
- Benefits eligibility starting on day one
- Potential bonus or incentive based on business need
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What This Job Offers
Job Type
Full-time
Career Level
Entry Level
Education Level
High school or GED
