Medical Benefit Review Services Associate II

Medical Benefit Review Services Associate II – Pharmacy is responsible for providing analytical support to CPIS overpayment programs via access to the client claims systems related to Medicare Part D, Medicaid and Commercial pharmacy claim overpayments identified through various audits. 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 vestigates and communicates questionable situations.Documents findings from the client system in the related municates effectively with other staff/team members.Works independently based on established procedures.Experience:Background in pharmacy 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.Knowledge of Microsoft Office systems, including excel and working spreadsheets. Education: High School Diploma, GED, or equivalent combination of education and experience.

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