Medical Benefit Review Services Associate

Conduent; Central City (NE); A distancia; USD 34.000 - 43.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Fully remote position

Flexible Monday-Friday schedule

No weekends required

Benefits day 1 eligibility

Competitive starting pay

Descripción de la vacante

Conduent is seeking a Medical Benefits Review Associate to analyze Medicare, Medicaid and Commercial overpayments in a fast-paced, fully remote environment. You will review paid, adjusted, and offset claims and verify member eligibility while working with client systems.

This role requires attention to detail, strong research and communication skills, and the ability to work independently within established procedures.

Formación

• Must have a high school diploma or GED.
• Background in benefit/coverage concepts is desirable.
• Proficiency with Microsoft Office (Word, Excel, Outlook) and data entry experience.

Responsabilidades

• Review of paid, adjusted, and offset claims in the client system.
• Review of member eligibility and update eligibility accordingly.
• Investigates and communicates questionable situations.
• Documents findings in related systems.
• Communicates effectively with staff and teammates.
• Works independently based on established procedures.

Conocimientos

Analytical skills

Communication

Data entry

Investigative reasoning

Educación

High school diploma or GED

Herramientas

Microsoft Office

Claims systems

Descripción del empleo

Medical Benefits Review Associate

Pay: Starting at $18.00/hour (based on experience), which may be below your state's minimum wage. Please take this into consideration when applying.

Schedule: Monday-Friday | 8:00 AM -4:30 PM EST

Location: Fully Remote

About this role:

Are you experienced in various types of medical benefits and services? We're looking for a detail-oriented healthcare professional who enjoys solving complex insurance billing and coverage issues and working in a fast-paced remote environment.

Medical Benefit Review Services Associate II is responsible for providing analytical support to CPIS overpayment programs via access to the client claims systems related to Medicare, Medicaid and Commercial claim overpayments identified through various audits.

If you have strong analytical skills, enjoy researching insurance eligibility and medical claims and take pride in delivering accurate, high-quality work, we'd love to hear from you.

Key Responsibilities

• Responsibilities include (but are not limited to):
• Review of paid claims, adjusted claims, and offset claims in the client system.
• Review of member eligibility, update of member eligibility.
• Investigates and communicates questionable situations.
• Documents findings from the client system in the related systems.
• Communicate effectively with other staff/team members.
• Works independently based on established procedures.

Required Qualifications

• Must be 18 or older to apply
• Must have a high school diploma or GED
• Must be able to successfully pass a preemployment criminal background check and drug screening
• Background in benefit/coverage concepts desired
• Basic knowledge of insurance procedures, working with insurance carriers, Medicare, and Medicaid
• Experience with data entry / medical claims data entry processing
• Professional verbal and written communication skills required
• Proficiency with Microsoft Office (Word, Excel, and Outlook)
• Understanding of medical terminology and healthcare eligibility processes
• Strong investigative, research, and critical thinking skills
• Excellent verbal and written communication skills
• Strong organizational and multitasking abilities
• Ability to work independently while collaborating effectively with a remote team

Why You'll Love This Opportunity

• Fully remote position
• Flexible Monday-Friday schedule
• No weekends required
• Competitive starting pay
• Collaborative team environment
• Eligible for benefits day 1

Due to varying state and local minimum wage laws, we are currently only able to hire candidates residing in states where our compensation structure complies with applicable wage regulations. As a result, we may be unable to consider applicants from certain states or municipalities at this time.

Requirements

• Must pass an internet speed test (download equal to or greater than 25, upload equal to or greater than 5, Ping ms equal to or less than 175)
• Must have the ability to connect with an ethernet cable to a modem/router
• Live in one of the following 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, WY

We are currently NOT hiring in the following geographies, included but not limited to

States: AK, CA, CT, HI, MA, IL, MT & NY

Metro Areas: MN – Minneapolis, IL – Chicago, NY – New York City, OR - Portland, MD - Montgomery County, WA - Seattle, Washington, DC

Pay Transparency Laws in some locations require disclosure of compensation and/or benefits-related information. For this position, actual salaries will vary and may be above or below the range based on various factors including but not limited to location, experience, and performance. In addition to base pay, this position, based on business need, may be eligible for a bonus or incentive. In addition, Conduent provides a variety of benefits to employees including health insurance coverage, voluntary dental and vision programs, life and disability insurance, a retirement savings plan, paid holidays, and paid time off (PTO) or vacation and/or sick time. The estimated salary range for this role is $34,320-$42,900.

Through our dedicated associates, Conduent delivers mission-critical services and solutions on behalf of Fortune 100 companies and over 500 governments - creating exceptional outcomes for our clients and the millions of people who count on them. You have an opportunity to personally thrive, make a difference and be part of a culture where individuality is noticed and valued every day.

Conduent is an Equal Opportunity Employer and considers applicants for all positions without regard to race, color, creed, religion, ancestry, national origin, age, gender identity, gender expression, sex/gender, marital status, sexual orientation, physical or mental disability, medical condition, use of a guide dog or service animal, military/veteran status, citizenship status, basis of genetic information, or any other group protected by law.