Medical Claims Investigator at State of Nebraska

Lincoln, Nebraska, United States -

Full Time

Start Date

Immediate

Expiry Date

13 Feb, 26

Salary

21.041

Posted On

15 Nov, 25

Experience

2 year(s) or above

Remote Job

Yes

Telecommute

Yes

Sponsor Visa

Skills

Attention To Detail, Customer Service Skills, Computer Proficiency, Time Management, Problem-Solving, Communication Skills, Teamwork, Adaptability, Confidentiality Awareness, Analytical Skills

Industry

Government Administration

Description

The work we do matters! Hiring Agency: Health & Human Services - Agency 25 Location: Lincoln, NE Hiring Rate: $21.041 Job Posting: JR2025-00020903 Medical Claims Investigator (Open) Applications No Longer Accepted On (If no date is displayed, job is posted as open until closed): 11-25-2025 Job Description: 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. Investigate 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. Hiring Rate: $21.041 per hour. Non-Exempt Location: Lincoln NE – NSOB 5th floor- In office only Requirements / Qualifications: Minimum Qualifications: Graduation from a standard four-year high school, or its equivalence, 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: Experience with health insurance terminology/processes, Microsoft Office (Excel, Word, Outlook, etc.) databases, Medicaid Claims Processing, and Medicaid eligibility. Experience with C1/MMIS, N-FOCUS, and OnBase would be beneficial. Strong analytical and problem-solving skills, including the ability to interpret and apply regulations, identify discrepancies, and recommend appropriate actions. A professional, customer-focused approach when communicating with providers, clients, business partners and internal team members. Comfort using multiple computer systems and databases to research, update, verify and manage insurance related information efficiently. 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 Customer Service Skills – Ability to communicate clearly, listen actively, and handle questions or complaints with professionalism. Attention to Detail – Able to review forms and data accurately to catch errors or missing information. Computer Proficiency – Comfortable using Microsoft Office (Word, Excel, Outlook) and navigating multiple computer systems. Time Management – Capable of handling a high volume of work, staying organized, and meeting deadlines. Problem-Solving – Able to identify issues, think critically, and find practical solutions for customers or internal processes. Communication Skills – Strong written and verbal communication to explain processes, respond to inquiries, and document work. Teamwork – Willing to work cooperatively with others and assist team members when needed. Adaptability – Able to learn new systems, take on different tasks, and adjust to changes in a fast-paced environment. Confidentiality Awareness – Understands and follows privacy regulations like HIPAA when handling sensitive information. What we offer: State-matched retirement contribution of 156%! 13 paid holidays Generous leave accruals that begin immediately Tuition reimbursement program 79% employer-paid health insurance plans Dental and vision insurance plans Employer-paid $20,000 life insurance policy Career advancement opportunities as the largest and most diverse employer in the state Training and development based on your career goals Employee Assistance Program Benefits 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 Equal Opportunity Statement 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. Current employees of the State of Nebraska should NOT apply on this external career. Instead go to Workday and access the Jobs Hub - Internal Apply app from your home landing page. We are seeking talented individuals to join our team in careers that make a difference in the lives of Nebraskans. Once you've had the opportunity to explore our current open positions, apply for those of interest to you. Click here for a video tutorial. Contact state.jobs@nebraska.gov for additional support. Check back on your candidate profile to see the status of your submitted applications, as well as any new postings that might interest you! Thank you for your interest in joining our team! State Government is one of the largest and most diverse employers in Nebraska. Whether it's helping a vulnerable child, advancing public health, making highways safer, or preserving our natural resources, the work we do matters!

Responsibilities

As a Medical Claims Investigator, you will investigate health claims to ensure Medicaid is the payor of last resort. This role involves analyzing claims, resolving liability issues, and ensuring compliance with Medicaid policies.