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Claims Analyst

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Robert Half

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Location:
United States , Providence

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Category:
Insurance

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Contract Type:
Not provided

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Salary:

Not provided
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Job Description:

We are seeking a detail-oriented Claims Analyst for a long-term contract on site in Providence, RI. Strong experience in Coordination of Benefits (COB), orthodontic or medical claims processing, and suspended/pended claims resolution. This role requires a thorough understanding of industry guidelines, plan provisions, and claim adjudication processes to ensure accurate and timely claim outcomes.

Job Responsibility:

  • Coordination of Benefits (COB) Processing: Review and adjudicate claims to determine primary and secondary coverage in accordance with COB rules
  • Verify subscriber and dependent eligibility across multiple insurance plans
  • Apply industry-standard guidelines to ensure accurate benefit determination
  • Calculate correct payment amounts following primary insurer adjudication
  • Adjust claims based on Explanations of Benefits (EOBs) received from other carriers
  • Orthodontic Claims Processing: Evaluate orthodontic treatment plans for coverage eligibility and plan compliance
  • Verify lifetime maximums, age limits, and plan-specific orthodontic provisions
  • Process initial banding/bonding claims and ongoing periodic payments
  • Calculate prorated payments over the course of treatment
  • Monitor continuation of treatment and confirm ongoing patient eligibility
  • Suspended / Pended Claims Handling: Analyze suspended or pended claims to identify errors, missing documentation, or review flags
  • Determine root causes such as eligibility discrepancies, coding issues, or COB conflicts
  • Prioritize suspended claims based on aging, urgency, and service-level agreements (SLAs)
  • Escalate complex or high-risk issues to senior analysts or supervisors as appropriate
  • Ensure timely and compliant resolution in accordance with turnaround time standards

Requirements:

  • Prior experience in dental and/or healthcare claims processing preferred
  • Strong knowledge of COB rules, orthodontic benefits, and claim adjudication practices
  • Ability to interpret EOBs, plan documents, and coverage guidelines
  • Excellent analytical skills with strong attention to detail
  • Ability to manage multiple priorities and meet deadlines in a fast-paced environment
What we offer:
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in company 401(k) plan

Additional Information:

Job Posted:
April 12, 2026

Work Type:
On-site work
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