Claims Reviewer
Location: Remote
Compensation: To Be Discussed
Staff Reviewed: Tue, Nov 19, 2024
This job expires in: 16 days
Job Summary
A company is looking for a Claims Reviewer to conduct medical claims reviews and ensure compliance with processing guidelines.
Key Responsibilities
- Conducts medical claims review for medical necessity and appropriateness of care
- Validates medical determinations and prepares cases for review as needed
- Identifies and reports potential quality or fraud issues to management
Required Qualifications
- High School Diploma or GED
- 2+ years of claims review experience
- Knowledge of all types of medical claims review
COMPLETE JOB DESCRIPTION
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