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.
