Claims Rep II – GHA Redetermination Rep — Broadway Ventures
Broadway Ventures
Pay$22.00
LocationRemote - Approved U.S. States
Remote statusRemote
Phone levelLow phone
IndustryHealthcare / Medicare Claims
OccupationClaims Representative II
Job functionMedicare Redeterminations & Appeals
State restrictionsFL, GA, IL, IN, IA, MI, MN, MO, NE, NC, SC, TX, WI
Eligible countriesUnited States
RegionNorth America
Job Summary
Reviews first-level Medicare appeals, compares processed claims with Medicare policy and documentation, resolves edits and audits, adjudicates redeterminations, and prepares written determination notices.
Job Description
Reviews first-level Medicare appeals, compares processed claims with Medicare policy and documentation, resolves edits and audits, adjudicates redeterminations, and prepares written determination notices.
Additional Requirements & Compensation
Work authorizationCMS residency requirement: must have lived in the U.S. at least 3 of the last 5 years
LanguageStrong written English; letter-writing and grammar proficiency preferred
Time zoneInitial 4-week training Monday-Friday 7:30 AM-4:05 PM Central
Additional Job Details
High school diploma/equivalent is the minimum education requirement. Two years of recent Medicare customer service, claims processing or medical billing is preferred. CMS requires residence in the U.S. for at least 3 of the last 5 years. Four-week training is 7:30 AM-4:05 PM CST.
Posting Information
Posted date2026-09-21