PLS Review Specialist (168758)

Position Purpose :

Perform retrospective review of Emergency Room claims for benefit determination, according to the Prudent Layperson Standard (PLS) for emergency room visits and other non-clinical aspects of review.

Job Title : PLS Review Specialist

Location : RemoteIndiana

Hours : 11am - 5pm Mon-Fri or 10 : 30am - 5pm

• Weekly Pay

Responsibilities :

The PLS Review Specialists are responsible for reviewing Emergency Room (ER) claims to determine if utilization was appropriate or not. The purpose of the PLS Reviewer is to be representative of the population we serve and should not have claims or college experience so as to not bias their review of the claim. "Prudent Lay Person" : determining if the average person with no medical training / experience would have gone to the ER in that situation.

Experience :

1+ years of claims experience; experience with office equipment to include personal computer (dual monitor), Excel and Microsoft Office.No Medical training required but person draws on his / her own practical experience when making a decision whether an emergency medical condition is present wherein treatment is needed. Experience with office equipment to include personal computer and have experience with Excel and Microsoft Office.

Education :

High school diploma or equivalent.

Position Purpose :

Perform retrospective review of Emergency Room claims for benefit determination, according to the Prudent Layperson Standard (PLS) for emergency room visits and other non-clinical aspects of review.

Job Title : PLS Review Specialist

Location : RemoteIndiana

Hours : 11am - 5pm Mon-Fri or 10 : 30am - 5pm

Responsibilities :

The PLS Review Specialists are responsible for reviewing Emergency Room (ER) claims to determine if utilization was appropriate or not. The purpose of the PLS Reviewer is to be representative of the population we serve and should not have claims or college experience so as to not bias their review of the claim. "Prudent Lay Person" : determining if the average person with no medical training / experience would have gone to the ER in that situation.

Experience :

1+ years of claims experience; experience with office equipment to include personal computer (dual monitor), Excel and Microsoft Office.No Medical training required but person draws on his / her own practical experience when making a decision whether an emergency medical condition is present wherein treatment is needed. Experience with office equipment to include personal computer and have experience with Excel and Microsoft Office. Contingent Staff to be utilized to allow for a maximum of two years duration in this position."

Education :

High school diploma or equivalent.