Medical Claims Investigator

A company is looking for a Coordination of Benefits - Medical Claims Investigator.

Key Responsibilities

Review medical claims against provider contracts to ensure accurate payment processing

Utilize data mining techniques to analyze hospital and physician claims for errors

Promote a collaborative team environment focused on achieving production and quality goals

Required Qualifications, Training, and Education

Minimum high school diploma or GED with two years of experience in medical claims investigation or data mining

Knowledge of medical coding and reimbursement structures

Proficiency in medical terminology and coding guidelines

Familiarity with automated medical claims payment systems

Advanced computer skills, particularly in Microsoft Excel