Medical Claims Investigator

Job Summary

A company is looking for a Payment Integrity Coordination of Benefits Medical Investigator.

Key Responsibilities

• Review medical paid claims to ensure accurate processing against provider contracts
• 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 and Education

• Minimum high school diploma or GED with two years of experience in medical claims investigation or data mining
• Preferred medical billing and coding certification and a bachelor's degree in a relevant field
• Knowledge of coding edits and medical claim reimbursement structures
• Familiarity with automated medical claims payment systems
• Advanced computer skills, particularly in Microsoft Excel