Medical Claims Research Specialist

Employer Industry: Healthcare Services

• Opportunity for contract duration of 2-3 months with the potential for extension
• Flexible remote work arrangement
• Gain valuable experience in HEDIS reporting and medical claims research
• Collaborate with a supportive team of healthcare professionals
• Develop skills in medical terminology and claims systems
• Competitive working conditions with a focus on privacy and confidentiality

• Review medical claims reports to identify appropriate medical records and providers
• Follow internal workflows to complete daily project tasks related to HEDIS reportingLikelihood
• Conduct claims and provider research using claims reports and document findings
• Track claims research steps and outcomes using MS Excel and HEDIS software
• Collaborate with HEDIS team members to achieve project goals and participate in staff meetings

• High school diploma or equivalent
• Experience with medical terminology and provider specialties
• Familiarity with medical claims systems
• Strong proficiency in Microsoft Office Suite (MS Outlook, MS Excel)
• Excellent interpersonal and communication skills, both written and verbal

• Previous experience in a call center or customer service environment
• Healthcare experience related to HEDIS
• Ability to learn quickly and manage multiple activities simultaneously
• Strong data entry and typing skills
• Highly organized and detail-oriented

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