Medical Claims Investigator

Job Summary

A company is looking for a COB-Medical Claims Investigator.

Key Responsibilities

• Review medical paid claims against provider contracts and policies for accuracy
• Utilize data mining techniques to analyze and audit hospital and physician claims
• Ensure compliance with HIPAA regulations while promoting a positive team environment

Required Qualifications

• Minimum high school diploma or GED with two years of experience in medical claims investigation
• Knowledge of coding edits and medical claim reimbursement structures
• Proficiency in medical terminology and coding principles
• Familiarity with automated medical claims payment systems
• Advanced computer skills, particularly in Microsoft Excel