Medical Reviewer (Fully Remote)

Palmetto GBA, LLC; United States; Hybrid; USD 42,000 - 64,000; Full time

Job summary

Palmetto GBA is a healthcare administrator and one of the nation's largest medical claims processors. The company, part of BlueCross BlueShield of South Carolina, has served clients for 70+ years and offers training and tuition assistance.

The on-site six-month training in Myrtle Beach, SC leads to remote work thereafter. Responsibilities include reviewing medical records to determine benefits eligibility and documenting decisions using clinical guidelines.

Qualifications

• Active LPN/LVN or LBSW license with two years of clinical experience.
• Proficiency in Microsoft Office and strong analytical and customer service skills.

Responsibilities

• Review medical records to determine necessity for benefits and appeals.
• Document decisions using clinical guidelines and support claims.

Skills

LPN/LVN license

LBSW license

Tools

Microsoft Office

Job description

• Review medical records to determine necessity for benefits and appeals.
• Document decisions using clinical guidelines and support claims.

Work Arrangement:

• On-site in Myrtle Beach, SC for six months of training, then remote.
• Monday-Friday, 8am-5pm with nights, weekends, and holidays off.

Qualifications:

• Active LPN/LVN or LBSW license with two years of clinical experience.
• Proficiency in Microsoft Office and strong analytical and customer service skills.

Palmetto GBA is a healthcare administrator and one of the nation's largest medical claims processors. As part of BlueCross BlueShield of South Carolina, we've served clients for 70+ years and offer training and tuition assistance.