VirtualVocations

At Home Medical Review Spec I

WellPoint is the nation's leading health benefits company. At WellPoint, we are dedicated to improving the lives of the people we serve and the health of our communities. WellPoint strives to be the most trusted choice for consumers and a leader in affordable quality care with an unyielding commitment to meeting the needs of our diverse customers.

Bring your expertise to our innovative, performance-focused culture, and you will discover lasting rewards and the opportunity to take your career further than you can imagine. 

Reviews and analyzes institutional and professional claims and supporting medical documents to determine medical necessity of billed services and benefits payable according to established guidelines. Primary duties include, but are not limited to: Reviews, analyzes and renders determinations on requests from the providers and beneficiaries for reconsideration of previously rendered medical decisions relating to claims issues.

This is an entry level Medical Review position. 2 years of college or the equivalent and a minimum of 4 years health care experience or any combination of education and experience, which would provide an equivalent background. Current unrestricted California RN license is required. This may be a telecommuting position.

Employer Posted:Monday, August 25, 2008