Medical Review Spec I (Job Family) - 19630SY

WellPoint is the nation's leading health benefits company serving the needs of approximately 28 million medical members nationwide.

Reviews and analyzes institutional and professional claims and supporting medical documents to determine medical necessity of billed services and benefits payable according to established guidelines. Reviews, analyzes and renders determinations on requests from the providers and beneficiaries for reconsideration of previously rendered medical decisions relating to claims issues. This is an entry level Medical Review position.

Two years of college or the equivalent and a minimum of four years health care experience or any combination of education and experience providing an equivalent background. Must have excellent written and verbal communication skills. Must have PC knowledge. Current applicable state RN or LVN license is required.