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 to ensure accurate processing
• Utilize data mining techniques to analyze claims and identify savings opportunities
• Mentor junior team members and assist in managing departmental productivity and quality goals

Required Qualifications

• Minimum high school diploma or GED with four years of experience in medical claims investigation
• Relevant medical billing and coding certification preferred
• Advanced knowledge of coding edits and medical claim reimbursement structures
• Expertise in COB NAIC Guidelines and federal/state regulations
• Proficiency with automated medical claims payment systems and Microsoft Excel