Senior Medical Claims Investigator

Job Summary

A company is looking for a Senior Medical Claims Investigator.

Key Responsibilities

• Review medical claims against provider contracts and policies for accuracy
• Utilize data mining techniques to analyze claims and identify savings opportunities
• Mentor junior team members and assist in achieving departmental productivity and quality goals

Required Qualifications

• Minimum high school diploma or GED with four years of relevant experience; relevant certification and bachelor's degree preferred
• Advanced knowledge of medical coding and reimbursement structures
• Expertise in COB NAIC Guidelines and federal/state healthcare regulations
• Experience with medical claims payment systems and proficiency in Microsoft Excel
• Ability to work independently and prioritize tasks effectively