Job DescriptionJob DescriptionPosition Title :Claims ReviewerLocation :Remote (But must reside in approved states)Employment Type :Full-TimeAbout the RoleWe are seeking a detail-oriented contract-to-hire Claims Reviewer to join our team! In this role, you will conduct retrospective reviews of medical and behavioral health claims for both inpatient and outpatient services.You will apply your clinical, coding, and processing knowledge to ensure claims are accurate, compliant, and appropriately reimbursed according to program benefits.Key ResponsibilitiesPerform detailed reviews of medical claims using established clinical criteria and guidelines (e.g., CDST, CPT, HCPCS, ICD-10).Validate medical necessity, appropriateness of care, and adherence to program exclusions, limitations, and benefits.Collaborate with medical directors, providers, and claims teams to resolve coding or clinical questions.Prepare claims for payment review or escalate to medical director if necessary.Identify and report potential quality or fraud issues to management and relevant departments (e.g., Quality Management, Program Integrity).Review claims data to recommend process improvements and support accurate claims payment.Ensure compliance with contract timelines for claims resolution.Maintain consistent production standards and meet processing quotas.Communicate effectively across teams to support operational excellence.QualificationsRequired :High school diploma or GED.At least 2 years of claims review experience.Knowledge of medical claims review processes for inpatient and outpatient services.Preferred :Coding experience with CPT, HCPCS, and ICD-10.Familiarity with behavioral health claims.Key Competencies :Strong knowledge of claims processing tools such as Supercoder and Clinical Decision Support Tool.Ability to evaluate clinical documentation for compliance and accuracy.Organizational skills with the ability to manage multiple priorities in a fast-paced environment.Effective communication and collaboration with internal and external stakeholders.Proficiency in Microsoft Office Suite and department-specific applications.Working ConditionsFully remote position; must have reliable internet and a distraction-free workspace.Prolonged sitting and extensive computer work required.Why Join Us?This is an opportunity to work in a dynamic, mission-driven environment where your skills and expertise in claims review will make a meaningful impact.We offer competitive compensation, comprehensive benefits, and a collaborative remote work culture..
Claims Reviewer (Remote) • Litchfield Park, AZ, United States
Who is Federated Insurance?At Federated Insurance, we do life-changing work, focused on our clients' success.For our employees, we provide tremendous opportunities for growth.Over 95% of them belie... Show more
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Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
At Federated Insurance, we do life-changing work, focused on our clients' success.For our employees, we provide tremendous opportunities for growth.Over 95% of them believe our company has an outst... Show more
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Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
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Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Product Testers are wanted to work from home nationwide in the US to fulfill upcoming contracts with national and international companies.We guarantee 15-25 hours per week with an hourly pay of bet... Show more
Avondale, Arizona, United States.For over 80 years, Ernest has been committed to the success of our extended family, our customers, our employees, and the packaging industry itself.When you work wi... Show more
