Claims auditor [h1.location_city]

Medical Claims Investigator

The work we do matters! Hiring Agency : Health & Human Services - Agency 25 Location : Lincoln, NE Hiring Rate : $21.041 per hour. Non-Exempt

Location : Lincoln NE NSOB 5th floor- In office only

We're seeking candidates who bring a strong attention to detail and a commitment to accuracy, along with the ability to work effectively in a structured, fast-paced environment. Join Our Team! Are you looking for a workplace where your attention to detail, passion for helping others, and love for teamwork are valued and make a difference every day? Join our dedicated team at the Department of Health and Human Services as a Medical Claims Investigator in our Medicaid and Long-Term Care Claims Division. We are committed to service, collaboration, and making an impact on the lives of Nebraskans and we like to have a little fun along the way! As a Medical Claims Investigator for the Recovery and Cost Avoidance team you'll play a vital role in ensuring Medicaid appropriately remains the payor of last resort for health and casualty claims. This detail-oriented role involves investigating the circumstances surrounding health claims when there is indication that payment for the claim may be obtained from sources other than Title XIX Medicaid funds.

As a Medical Claims Investigator, you will :

• Answer and direct calls placed or referred to the Coordination of Benefits / Casualty call line.
• Analyze claims for payor accuracy, investigate and resolve liability issues, and ensure compliance with Medicaid policies and procedures.
• Communicate with team members to address claim inquiries and support both internal teams and external partners.
• Initiate research and bring resolution to processed claims which may have been processed and paid and now need to be recouped and billed to a liable third-party resource.
• Research extent and sources of third-party liability for medical claims payment and ensure these payments are fully utilized.
• Perform Third Party verifications and accurately enter the findings into a database.
• Collaborate with appropriate program staff to report and follow-up if fraud, waste or abuse activities are identified.
• Perform related work as assigned.

Minimum Qualifications : Graduation from a standard four year high school, or its equivalency, four years full-time professional experience, plus one year of full-time paid employment in a responsible position performing duties related to investigative research, such as, police investigation, insurance investigation, or account collections. College work with emphasis in business administration, management, public administration, accounting, behavioral sciences, or closely related fields, may be substituted for the above general experience on a year for year basis with a maximum substitution of four years. There shall be no substitution for the one year of investigative research experience.

Preferred Qualifications :

If you're detail-oriented, dependable, and ready to support our mission of helping Nebraskans we'd love to hear from you!

Knowledge, Skills, and Abilities :

What we offer :

If you're currently employed by the State of Nebraska, please don't apply through this external career site. Instead, log in to Workday and open the Jobs Hub - Internal Apply app from your home landing page.

We offer a comprehensive package of pay, benefits, paid time off, retirement and professional development opportunities to help you get the most out of your career and life. Your paycheck is just part of your total compensation. Check out all that the State of Nebraska has to offer! Benefit eligibility may vary by position, agency and employment status. For more information on benefits, please visit : https : / / statejobs.nebraska.gov / index.html#benefits

The State of Nebraska values our teammates as well as a supportive environment that strives to promote diversity, inclusion, and belonging. We recruit, hire, train, and promote in all job classifications and at all levels without regard to race, color, religion, sex. age, national origin, disability, marital status or genetics.