Medical Claims Research Specialist
: Job Details :

Duration: 2-3 months Contract (with the possibility of extension)

Employment type : W2

Job Summary: The Medical Claims Research Specialist supports the HEDIS (Healthcare Effectiveness Data and Information Set) reporting period by reviewing medical claims, identifying appropriate medical records and providers, and documenting follow-up actions. This role operates under the direction of Quality Program Managers, ensuring timely and accurate data collection.

Key Responsibilities:

· Learn basic HEDIS principles through internal training.

· Follow workflows to complete daily tasks.

· Conduct claims and provider research using claims reports.

· Track research steps and outcomes using MS Excel and HEDIS software.

· Validate provider locations and send HEDIS requests via fax.

· Collaborate with the HEDIS team to meet project goals.

· Complete follow-up phone calls as needed and attend project meetings.

Qualifications:

· Education: High school diploma or equivalent.

· Experience:

o Knowledge of medical terminology and provider specialties.

o Experience with medical claims systems or HEDIS processes.

o Background in healthcare, call centers, or customer service.

Skills:

· Proficiency in Microsoft Office Suite (Outlook, Excel).

· Ability to learn quickly and follow complex workflows.

· Strong decision-making, problem-solving, and communication skills.

· Attention to detail, organizational skills, and self-motivation.

· Ability to work independently and manage multiple tasks.

Working Conditions:

· Remote work with a secure internet connection required.

· Must adhere to privacy and confidentiality policies.