Claims Analyst II

As a Claims Analyst II, you will conduct moderately complex reviews of claims during the course of fraud investigations or other program integrity initiatives. This involves applying Medicare guidelines, an extensive knowledge of medical terminology, and experience in the analysis and processing of Medicare claims in making determinations as to the appropriateness of payment coverage. You'll review information contained in Standard Claims Processing System files to determine provider billing patterns and to detect potentially fraudulent or abusive billing practices or vulnerabilities in Medicare payment policies. You will also compile the written Investigative Summary Report.