Job Description
About Conduent
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.
Job Description
Medical Benefit Review Services Associate II – Pharmacy
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 eligibility.
- Investigates and communicates questionable situations.
- Documents findings from the client system in the related systems.
- Communicates effectively with other staff/team members.
- Works independently based on established procedures.
Training: 2 weeks M-F, 6am – 2:30pm PST / 6:30am – 3pm PST
Work Hours: Monday – Friday, 6am – 2:30pm PST / 6:30am – 3pm PST
Pay: Min- $17/hourly
Full Time – regular position
Equipment provided [Laptop & Headphones]
This a Remote / WFH position
Requirements:
Must be at least 18 years of age with at High School Diploma or a GED.
Must pass a criminal background check and drug screening.
Must have WIRED internet connection, WIFI is not permitted.
Preferred:
Experience with Microsoft Office Excel.
Experience with data entry / medical claims data entry processing.
Basic knowledge of insurance procedures, working with insurance carriers, Medicare, and Medicaid.
Background in pharmacy benefit/coverage concepts desired.