Medical Reviewer II - Palmetto GBA

What you’d do

Review medical claims for complex services, preauthorization, appeals, fraud referrals, and coding accuracy. Determine medical necessity and coverage for claims, document rationale, and educate staff. Full-time work from home in South Carolina. Found on the employer's careers page on Oct 23, 2026. Apply through the link.

You’ll need

• 5 years RN nursing experience
• Experience in Medical/Utilization Review or related fields
• Knowledge of Medicare or claims processing
• Ability to use multiple Windows-based programs