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 to review Medicare, Medicaid, and commercial claim overpayments identified through various audits. The role is suited to a detail-oriented healthcare professional who can research insurance eligibility and medical claims, resolve complex insurance billing and coverage issues, and deliver accurate, high-quality work in a fast-paced remote environment. This is a fully remote position with a Monday-Friday schedule from 8:00 AM to 4:30 PM EST. Candidates must reside in an eligible state, meet the stated internet speed requirements, and be able to connect to a modem or router using an Ethernet cable. The role starts at $18.00 per hour based on experience; the posting also lists an estimated salary range of $34,320-$42,900. Actual compensation may vary by location, experience, and performance. The position may be eligible for a bonus or incentive based on business need. Benefits are available from day one.
Requirements
- Must be at least 18 years old.
- Must have a high school diploma or GED.
- 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 Office, including 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.
- Pass an internet speed test with download speed of at least 25, upload speed of at least 5, and ping of no more than 175 ms.
- Ability to connect to a modem or router using an Ethernet cable.
- Reside in one of the listed eligible 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, or WY. The posting also identifies certain states and metro areas where it is not hiring.
Nice To Haves
- Background in benefit and coverage concepts.
- Experience in medical benefits, insurance verification, medical billing, or healthcare claims.
Responsibilities
- Review paid claims, adjusted claims, 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 according to established procedures.
Benefits
- Health insurance coverage
- Voluntary dental programs
- Voluntary vision programs
- Life insurance
- Disability insurance
- Retirement savings plan
- Paid holidays
- Paid time off (PTO), vacation, and/or sick time
- Benefits eligibility from day one
- Potential bonus or incentive based on business need
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What This Job Offers
Job Type
Full-time
Education Level
High school or GED
