Senior Medical Claims Investigator

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

Jun 11, 2025 - 09:00

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