Independent Review Specialist

ABOUT US

Ethos Risk Services is a leading insurance claims investigation and medical management company committed to providing better data that translates into better decision-making for our clients. We are at the forefront of innovation in our space, and our success is driven by a dynamic team passionate about delivering exceptional services to our customers.

JOB SUMMARY

Our dynamic Ethos team is seeking an entry-level full-time Independent Review Specialist (REMOTE). This position is responsible for the efficient, accurate, and timely processing of Utilization Management and Independent Review requests for our Medical Management division clients. Key responsibilities include client communication via phone and email, scheduling peer-to-peer calls for Physician Advisors, requesting additional medical information, and processing client requests through the portal.

KEY RESPONSIBILITIES:

• Review Independent Review (IR) requests for organizational conflicts of interest.
• Maintain security and confidentiality of individually identifiable health information.
• Ensure compliance with client, state, federal, and URAC requirements.
• Perform duties in accordance with established policies and procedures within required timeframes.
• Responsible for reviewing and finalizing accurate reports for our medical management clients.

QUALIFICATIONS

Education:

• High School Diploma or GED required.

Experience/Skills:

• Preferably at least1 year of experience in a healthcare or investigative setting.
• Customer service experience with excellent phone etiquette.
• Understanding or familiarity HIPAA rules and regulations.
• Strong written and verbal communication skills.
• Proficiency in Microsoft Suite (Word and Excel) and Adobe Acrobat.

WORKING CONDITIONS

• This role is 100% remote and requires a designated workspace with a strong and reliable internet connection.
• Constant communication via telephone and virtual platforms with clients, customers, and co-workers.