Medical Claims Analyst

Description

We are offering a short term contract employment opportunity for a Medical Claims Analyst in the insurance industry, based in Plantation, Florida. This role involves managing the revised claims process, leading a team of claims processors, and ensuring claims are filed in a timely manner.

Responsibilities

• Oversee the end-to-end process of claims submission, evaluation, and resolution in compliance with company policies
• Review claims to ascertain their validity, completeness, and compliance with policy terms
• Communicate with members, healthcare providers, and other stakeholders to gather necessary information and provide updates on the status of claims
• Lead and mentor a team of claims specialists, providing guidance, training, and support to ensure productivity and quality of work
• Monitor claims data, generate reports, and analyze trends to identify areas for improvement in the claims process
• Ensure that the claims process complies with all relevant regulations, policies, and procedures, including state and federal laws governing healthcare and insurance
• Address any disputes or escalations related to claims, working to resolve issues in a fair manner to both the company and the member.
  
  
  

Requirements

• Proficiency in Allscripts and Cerner Technologies required
• Familiarity with Cl Programming and CMS Platform necessary
• Must have strong computer skills and be comfortable with various computer programs
• Experience in handling appeals in the insurance industry preferred
• Proven track record in auditing, ideally in the medical claims field
• Knowledge of benefit functions within the insurance industry required
• Familiarity with billing functions, particularly in the healthcare sector
• Must have experience in claim administration within the insurance industry
• Ability to work in a team and communicate effectively with different stakeholders
• Strong analytical skills and attention to detail
• Knowledge of insurance industry regulations and guidelines
• Ability to handle sensitive information with utmost confidentiality
• Must have excellent problem-solving skills and a strong work ethic
• Bachelor's degree in a related field or equivalent work experience required.
  
  
  

Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.

Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go.

All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available including medical, vision, dental, life and disability insurance. Employees hired for our FTEP Program are also eligible to enroll in our company’s 401(k) or deferred compensation plan (if eligible). FTEP employees also earn paid time off for vacation, personal needs, and sick time and paid holidays. The amount of Choice Time Off (CTO) received varies based on years of service and is pro-rated based on the hours worked per week. A new FTEP employee earns up to 13 days of CTO and up to 10 paid holidays per calendar year. Learn more at

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