Medical Claims Specialist Job
CGI - Cleveland, OH

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Job Order: J0612-0759 - Permanent Full Time
Title: Medical Claims Specialist
Category: Consulting / Business / Functional
City: Cleveland, Ohio, United States

Job Description: Medical Claims Specialist

CGI Federal, a wholly owned subsidiary of CGI and an industry leader in providing medical claims auditing services to healthcare payers throughout the US, is conducting a recruitment campaign in Cleveland, OH for Medical Claims Specialists. These individuals will be assigned to a large Medicare Secondary Payer (MSP) project. The mission of the MSP Project is to recover payments that were paid by Medicare when another entity had primary payment responsibility. To that end, Medical Claims Specialist will be responsible for the following:

- Follow up on leads provided by CMS involving claims that should have been paid by another
payer rather than Medicare
- Confirm which insurer should have been the primary payer
- Initiate a demand process with insurance companies including evaluation of beneficiary
- Track correspondence through demand process to ensure timely response within Service
Level Agreements
- Facilitate and document communication with insurers and employer groups
- Answer incoming queries via the telephone, email and hard copy
- Provide accurate and timely responses to queries
- Escalate outlying queries that have special circumstances to supervisors in alignment
with prescribed processes

To be considered for these roles, applicants must have a successful work history involving the following skills, abilities and credentials:
- Knowledge of Coordination of Benefits (COB)
- Strong analytical skills
- Ability to effectively use a PC , including basic/intermediate skills in MS Office
- Ability to multitask in a deadline-driven work environment
- Attention to detail while maintaining focus on overall mission
- Strong organization/time management skills
- Ability to quickly learn new methods/processes as needed
- Willingness to work as an individual performer and team player, as well as share
useful information with team to achieve common goals
- Knowledge of health insurance claims processing; Medicare is preferred
- Strong verbal and written communication skills
- HS Degree or GED is required At CGI, we're a team of builders. We call our employees members because all who join CGI are building their own company - one that has grown to 72,000 professionals located in more than 40 countries. Founded in 1976, CGI is a leading IT and business process services firm committed to helping clients succeed. We have the global resources, expertise, stability and dedicated professionals needed to achieve results for our clients - and for our members. Come grow with us. Learn more at

This is a great opportunity to join a winning team. CGI offers a competitive compensation package with opportunities for growth and professional development. Benefits for full-time, permanent members start on the first day of employment and include a paid time-off program and profit participation and stock purchase plans.

We wish to thank all applicants for their interest and effort in applying for this position, however, only candidates selected for interviews will be contacted.

No unsolicited agency referrals please.


- Client Relationship
- Detail-oriented
- Listening
- Microsoft Office
- Multi-tasking
- Performs Well Under Pressure

Reference: 201735

CGI - 17 months ago - save job - block
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