• Performs medical claim reviews for one or more of the following: claims for medically complex services, services that require preauthorization/predetermination, requests for appeal or reconsideration, referrals for potential fraud and/or abuse, and correct coding for claims/operations • Makes reasonable charge payment determinations based on clinical/medical information and established criteria/protocol sets or clinical guidelines • Determines medical necessity and appropriateness and/or reasonableness and necessity for coverage and reimbursement • Documents medical rationale to justify payment or denial of services and/or supplies • Educates internal/external staff regarding medical reviews, medical terminology, coverage determinations, coding procedures, etc. in accordance with contractor guidelines • Participates in quality control activities in support of the corporate and team-based objectives • Provides guidance, direction, and input as needed to LPN team members • Provides education to non-medical staff through discussions, team meetings, classroom participation and feedback • Assists with special projects and specialty duties/responsibilities as assigned by Management

• Provide operational support to the Medical Review Manager and the Medical Review Staff in managing production related to claims determinations and review • Serve as a critical component in meeting our mission of providing excellent services to our clients. • Ensure an exciting and rewarding opportunity to be at the forefront of activities related to implementing healthcare reform on a national level. • Review and analyze sampled Medicare claims using associated medical records to make payment determinations based on coverage, coding, and utilization of services. • Make medical necessity determinations utilizing clinical review judgment in accordance with the CERT Program policies and contract responsibilities. • Serve as a resource for medical review specialists involving coverage, coding, and medical necessity issues. • Conduct in-depth claims analysis utilizing ICD-9-CM, ICD-10-CM, CPT-4, and HCPCS Level II coding principles. • Conduct medical record audits to determine the medical necessity and/or appropriateness of medical treatment using CMS and other national guidelines.

Role Description You’ll help shape AI used by millions every day. As a Digital Ads Quality Analyst, you’ll review online ads and provide real human feedback that makes digital advertising smarter, safer, and more relevant for users in Türkiye and across Europe — all from home, on your own schedule. - Evaluate how well ads match what users in Türkiye and German‑speaking markets are searching for - Assess ad quality, language accuracy, and cultural relevance - Provide clear, honest feedback to improve ad performance - Contribute your human perspective to AI training - Work at your own pace, task by task Qualifications - Fluent in German and English (professional level) - Living in Türkiye (local cultural knowledge is essential) - Regular experience using social media and browsing the web - Reliable internet connection and a computer with antivirus - A smartphone (Android 4.1+ or iOS 8+) - Strong attention to detail and good communication skills - An English CV ready to upload Requirements - Language Check — Show your English and German skills - Knowledge Exam — Open‑book, with study materials provided - ID Verification — Standard security step Benefits - Support Designed for Remote Work - 24/7 confidential access to emotional, psychological, and practical support - 90‑day aftercare after leaving the program - Free Headspace Premium for mindfulness, focus, and better sleep - Fast support with responses within 24 hours - Proactive protection against stressful content - Regular wellbeing resources and training - Join 1M+ human raters improving AI for leading global technology companies - Be part of a diverse international community of digital professionals - See your work influence technology used worldwide - 100% remote — work from anywhere in Türkiye - Fully flexible hours (long‑term project) - No previous professional experience required

• Perform accurate and timely medical review of claims suspended for medical necessity • Initiate and/or respond to correspondence from providers or members concerning medical determinations