Medical Claims Investigator

Job Summary

A company is looking for a Medical Claims Investigator.

Key Responsibilities:

• Achieve measured production, quality, and growth results
• Utilize analytics and data mining techniques to analyze and audit medical claims
• Evaluate medical claims for coding and pricing errors using accurate codes

Required Qualifications:

• Minimum high school diploma or GED
• Two years of experience in medical claims investigation or data mining/coordination of benefits auditing
• Knowledge of coding type edits and medical claim reimbursement structures
• Proficiency with medical terminology and procedures
• Experience in applying principles of coding guidelines and regulations