Medical Claims Research Specialist

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 : Knowledge of medical terminology and provider specialties.Experience with medical claims systems or HEDIS processes.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.About US Tech Solutions : US Tech Solutions is a global staff augmentation firm providing a wide range of talent on-demand and total workforce solutions. To know more about US Tech Solutions, please visit www.ustechsolutions.com () ." US Tech Solutions is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, disability, or status as a protected veteran. "