Medical Records Examiner

hace 2 días


San Juan, San Juan, Puerto Rico Optum A tiempo completo

As a Medical Records Examiner, you will be responsible for reviewing medical records to determine the accuracy of claims submissions.

This role requires strong analytical skills to review medical records and interpret data to understand historical claims activity. The examiner will also communicate complex information to senior leadership and provide written or verbal explanations.

The primary responsibilities include investigating, reviewing, and providing clinical expertise in claim reviews. This involves interpreting state and federal mandates, billing practices, and applicable benefit language.

Key Responsibilities:

  • Investigate and review medical records to determine accuracy
  • Analyze data to understand historical claims activity
  • Provide written or verbal explanations for complex information
  • Communicate with senior leadership to resolve issues
  • Interpret state and federal mandates, billing practices, and applicable benefit language


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