Medical Claims Investigator
Naperville, IL 
Posted 2 days ago
Job Description
Job Description

Imagine a workplace that encourages you to interpret, innovate and inspire. Our employees do just that by helping healthcare payers manage the cost of care, improve competitiveness and inspire positive change. You can be part of an established company with a 40-year legacy that helps our customers thrive by interpreting our client's needs and tailoring innovative healthcare cost management solutions.

Our commitment to diversity, inclusion and belonging are part of the fabric of our company. We strive to create a workplace that fosters mutual respect and collaboration, where every talent individual can participate and perform their best work. We are MultiPlan and we are where bright people come to shine!

This role reviews medical paid claims against provider contracts and policies to ensure medical payments have been processed accurately. The incumbent will employ data mining techniques to analyze and audit hospital and physician claims to identify errant claim payments.

1. Achieve measured production, quality, and growth results.
2. Utilize analytics and data mining techniques to client paid claims data.
3. Evaluate medical claims for coding and pricing errors using accurate HCPCS, ICD-10, and CPT codes.
4. Lookup and review medical claims in payer system to determine methods of payment and validate savings identified.
5. Promote a positive team environment that is based around critical thinking and sharing intelligence to help meet both individual and team goals.
6. Utilize official coding guidelines and resources as required, including CMS directives and bulletins.
7. Collaborate, coordinate, and communicate across disciplines and departments.
8. Ensure compliance with HIPAA regulations and requirements.
9. Demonstrate Company's Core Competencies and values held within.
10. Please note due to the exposure of PHI sensitive data -- this role is considered to be a High Risk Role.
11. The position responsibilities outlined above are in no way to be construed as all encompassing. Other duties, responsibilities, and qualifications may be required and/or assigned as necessary.
This role keeps the needs of external and internal customers as a priority when making decisions and taking action. The incumbent works with limited supervision in the execution of the roles day-to-day responsibilities and may regularly interact with all levels of internal and external customers and staff within and outside the organization.
Note: This job cannot be performed in Colorado.
JOB REQUIREMENTS (Education, Experience, and Training):

* Minimum bachelors' degree or two (2) years of direct experience in medical claims investigation, auditing or data mining. Attainment of relevant medical billing and coding certification is highly preferred.
* Knowledge of coding type edits and medical claim reimbursement structures and methodologies
* Proficiency with medical terminology, medical procedures, medical conditions, and illness and treatment practices
* Employ experience in applying principles of coding guidelines; federal/state regulation, and policies pertaining to coding and billing
* Ability to independently- researchi state, federal, and commercial healthcare guidelines along with client specific standard operating procedures. Familiarity with automated medical claims payment systems and/or working knowledge of payer systems (i.e. Facets, QNXT, etc.)
* Advanced computer skills and proficiency with Microsoft Office products (Excel, Word, Outlook, SharePoint)
* Must be able to prioritize, coordinate, multitask, think outside the box, and be energetic
* Must be able to work independently while maintaining close attention to detail
* Required licensures, professional certifications, and/or Board certifications as applicable
* Individual in this position must be able to work in a standard office environment which requires sitting and viewing monitor(s) for extended periods of time, operating standard office equipment such as, but not limited to, a keyboard, copier and telephone


We realize that our employees are instrumental to our success, and we reward them accordingly with very competitive compensation and benefits packages, an incentive bonus program, as well as recognition and awards programs. Our work environment is friendly and supportive, and we offer flexible schedules whenever possible, as well as a wide range of live and web-based professional development and educational programs to prepare you for advancement opportunities.

Your benefits will include:

  • Medical, dental and vision coverage (low copay & deductible
  • Life insurance
  • Short- and long-term disability
  • 401(k) + match
  • Generous Paid Time Off
  • Paid company holidays
  • Tuition reimbursement
  • Flexible Spending Account
  • Employee Assistance Program
  • Summer Hours


MultiPlan is an Equal Opportunity Employer and complies with all applicable laws and regulations. Qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, sexual orientation, gender identity, national origin, disability or protected veteran status. If you'd like more information on your EEO rights under the law, please .

As an Equal Opportunity Employer, the Company will provide equal consideration to all employees and job candidates without regard to sex, age, race, marital status, sexual orientation, religion, national origin, citizenship status, physical or mental disability, political affiliation, service in the Armed Forces of the United States, or any other characteristic protected by federal, state, or local law. Equal Opportunity Employer Minorities/Women/Protected Veterans/Disabled


Job Summary
Start Date
As soon as possible
Employment Term and Type
Regular, Full Time
Required Education
Bachelor's Degree
Required Experience
2 years
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