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Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in reviewing and processing medical claims, with a strong understanding of insurance procedures, Medicare, and Medicaid. Capable of conducting thorough investigations and communicating findings effectively while maintaining high-quality work standards.
Highest-signal resume keywords
Medical Claims Data Entry ProcessingInsurance Procedures KnowledgeMicrosoft Office ProficiencyInvestigative Research SkillsOrganizational and Multitasking Abilities
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Medical Claims Data EntryInsurance ProceduresData AnalysisResearch SkillsMedical TerminologyHealthcare Eligibility Processes
Soft Skills
Professional Communication SkillsCritical ThinkingIndependenceCollaboration
Tools & Technologies
Microsoft WordMicrosoft ExcelMicrosoft OutlookClient Claims Systems
Certifications & Qualifications
High School DiplomaGED
Industry Keywords
MedicareMedicaidInsurance CarriersClaims ReviewEligibility Verification
About the role
Key responsibilities & impact- Review paid claims, adjusted claims, and offset claims in the client system
- Review and update member eligibility
- Investigate and communicate questionable situations
- Document findings from the client system in related systems
- Provide analytical support to CPIS overpayment programs
- Access client claims systems for Medicare, Medicaid, and Commercial claim overpayments identified through audits
- Communicate effectively with staff and team members
- Work independently based on established procedures
- Research insurance eligibility and medical claims
- Deliver accurate, high-quality work
Requirements
What you’ll need- Must be 18 or older to apply
- Must have a high school diploma or GED
- Must successfully pass a preemployment criminal background check and drug screening
- Basic knowledge of insurance procedures and experience working with insurance carriers, Medicare, and Medicaid
- Experience with data entry / medical claims data entry processing
- Professional verbal and written communication skills
- Proficiency with Microsoft Office (Word, Excel, and Outlook)
- Understanding of medical terminology and healthcare eligibility processes
- Strong investigative, research, and critical thinking skills
- Strong organizational and multitasking abilities
- Ability to work independently while collaborating effectively with a remote team
- Must pass an internet speed test: download ≥25 Mbps, upload ≥5 Mbps, ping ≤175 ms
- Must be able to connect with an ethernet cable to a modem/router
- Must live in an eligible listed state
- Must be able to work Monday-Friday, 8:00 AM-4:30 PM EST
Benefits
Comp & perks- Fully remote position
- Flexible Monday-Friday schedule
- No weekends required
- Competitive starting pay
- Collaborative team environment
- Eligible for benefits day 1
- Health insurance coverage
- Voluntary dental and vision programs
- Life and disability insurance
- Retirement savings plan
- Paid holidays
- Paid time off (PTO) or vacation and/or sick time
- Potential bonus or incentive based on business need