Claims and Denials Specialist Job at Robert Half (Oakland)

Rcm reimbursement specialist focused on appeals and denials

We are seeking an experienced and detail‑oriented RCM Reimbursement Specialist f...

Location

United States , Houston

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

College degree preferred, or equivalent experience (5+ years)
Minimum 5 years of medical billing experience, with strong preference for candidates experienced in molecular laboratory billing
Understanding of HIPAA regulations and proper handling of PHI
Solid working knowledge of health insurance plans, reimbursement policies, and claims terminology
Strong communication and interpersonal skills
Highly meticulous with strong analytical and problem‑solving abilities
Strong knowledge of insurance guidelines, CPT/ICD‑10 coding, and medical terminology
Excellent attention to detail and time management
Effective communication and problem‑solving abilities
Proficiency in Microsoft Office Suite and healthcare billing software tools

Job Responsibility

Resolve aged claims and appeals lacking payer responses through payer portals and outbound calls
Identify claims requiring first, second, or third‑level appeals
Support teammates with special projects and denial work queue management
Prioritize an assigned work queue to ensure timely follow‑up while maximizing reimbursement opportunity
Identify non‑payment trends and partner with Revenue Cycle leadership to escalate groups of claims to Market Access
Investigate denial and non‑payment trends identified by Revenue Cycle Analytics and collaborate cross‑functionally to propose and implement solutions
Communicate opportunities to improve upstream processes that may prevent future denials
Engage patients when their involvement is required during the appeal process
Collaborate professionally with Revenue Cycle team members and respond promptly to requests requiring assistance

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Claims Specialist II

Claims Specialist II – Coordination of Benefits (COB) Do you enjoy solving compl...

Location

United States

Salary:

Not provided

Tier4 Group

Expiration Date

Until further notice

Requirements

High School Diploma or equivalent
Minimum of two (2) years of medical claims processing experience
Strong analytical and investigative skills with the ability to resolve complex claims issues
Excellent written and verbal communication skills
Ability to prioritize and manage multiple tasks in a fast-paced environment
Proficiency with claims processing systems and Microsoft Office applications

Job Responsibility

Reviewing and processing medical claims with accuracy and attention to detail
Researching and resolving claim edits, denials, and payment discrepancies
Determining primary and secondary insurance coverage when members have multiple health plans
Applying Coordination of Benefits (COB) rules, including subscriber status, effective dates, plan types, and Medicare coordination guidelines
Updating claims and coverage records to ensure accurate claim adjudication
Investigating previously processed claims and making necessary benefit adjustments
Identifying and recovering overpayments through refunds, reprocessing, and recovery efforts
Communicating with members, providers, healthcare organizations, and insurance carriers to verify coverage and resolve claim issues
Reviewing quality audits and implementing corrections to maintain compliance and processing accuracy
Supporting special projects, process improvements, system updates, and departmental initiatives as needed

Medical Denials Specialist

We are seeking a detail-oriented Medical Denials Specialist to join our healthca...

Location

United States , Carmel

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
associate or bachelor’s degree preferred
2+ years of experience in medical billing, claims denial management or revenue cycle operations
Strong knowledge of EOBs, ERAs, CPT, ICD-10 and HCPCS codes
Experience with appeals, claim edits and insurance follow-up
Familiarity with Medicare, Medicaid and commercial payer regulations
Proficiency with electronic medical records and billing systems
Strong analytical, organizational and problem-solving skills
Excellent written and verbal communication skills
Ability to manage multiple priorities in a fast-paced environment

Job Responsibility

Review and investigate denied or underpaid medical claims
Identify denial trends and root causes to support process improvement
Prepare and submit claim corrections, reconsiderations and appeals
Follow up with insurance companies regarding claim status and payment resolution
Verify coding, billing and documentation accuracy to ensure compliance with payer requirements
Collaborate with billing, coding, collections and clinical teams to resolve claim issues
Maintain accurate records of denial activity, appeal outcomes and account updates
Monitor payer policy changes and reimbursement guidelines
Meet productivity and quality goals related to denial resolution and accounts receivable follow-up

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan

Fulltime

Sr. Claims Specialist

We are looking for an experienced Sr. Claims Specialist to support insurance fol...

Location

United States , Hinsdale

Salary:

70000.00 - 100000.00 USD / Year

Robert Half

Expiration Date

Until further notice

Requirements

Demonstrated experience handling insurance claims, claim investigations, or fraud-related file reviews in a high-volume setting.
Strong knowledge of the full claims process, from initial review and evidence analysis through adjudication and escalation.
Practical experience working with AI tools used in claims or fraud workflows, including scoring models, predictive analytics, or automated document and image review.
Ability to evaluate AI-generated findings, identify limitations, and make justified adjustments based on claim facts and compliance standards.
Hands-on familiarity with legacy claims systems as well as modern claims platforms that include embedded or integrated AI capabilities.
Solid understanding of documentation practices, including clear recording of claim decisions, supporting rationale, and AI-related overrides.
Knowledge of evidence standards for disputed claims, denials, and matters that may require litigation support.
Strong analytical ability, attention to detail, and skill in synthesizing information from multiple sources into accurate claim assessments.

Job Responsibility

Oversee an active caseload of claims, maintaining consistent review and follow-up to move files efficiently through investigation and resolution.
Examine claim records, supporting documents, statements, images, and prior file history to identify key facts, inconsistencies, and potential exposure.
Determine appropriate claim outcomes by applying policy guidance and evidence, including approvals, denials, or referral for legal escalation when warranted.
Use AI-supported resources such as fraud scoring, severity forecasting, image review, and document extraction tools to inform claim handling decisions.
Assess automated insights critically, confirming accuracy and using careful judgment to adjust or override recommendations when necessary.
Perform detailed fraud-related analysis on flagged claims to support fair, compliant, and well-documented decision-making.
Navigate both established claims applications and newer digital platforms to complete case activity and maintain workflow continuity.
Gather evidence manually across multiple systems and data sources when automated information is incomplete or requires verification.

What we offer

medical
vision
dental
life and disability insurance
401(k) plan

Fulltime

Medical Denials Specialist

We are seeking a detail-oriented Medical Denials Specialist to join our healthca...

Location

United States , Carmel

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
associate or bachelor’s degree preferred
2+ years of experience in medical billing, claims denial management or revenue cycle operations
Strong knowledge of EOBs, ERAs, CPT, ICD-10 and HCPCS codes
Experience with appeals, claim edits and insurance follow-up
Familiarity with Medicare, Medicaid and commercial payer regulations
Proficiency with electronic medical records and billing systems
Strong analytical, organizational and problem-solving skills
Excellent written and verbal communication skills
Ability to manage multiple priorities in a fast-paced environment

Job Responsibility

Review and investigate denied or underpaid medical claims
Identify denial trends and root causes to support process improvement
Prepare and submit claim corrections, reconsiderations and appeals
Follow up with insurance companies regarding claim status and payment resolution
Verify coding, billing and documentation accuracy to ensure compliance with payer requirements
Collaborate with billing, coding, collections and clinical teams to resolve claim issues
Maintain accurate records of denial activity, appeal outcomes and account updates
Monitor payer policy changes and reimbursement guidelines
Meet productivity and quality goals related to denial resolution and accounts receivable follow-up

What we offer

Medical insurance
Vision insurance
Dental insurance
Life insurance
Disability insurance
401(k) plan

Fulltime

Medical Denials Specialist

Join our dynamic healthcare team as a Medical Denials Specialist and play a key ...

Location

United States , Carmel

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High school diploma or equivalent required
associate’s or bachelor’s degree in healthcare administration or related field preferred
Minimum 2 years’ experience in medical billing, denials management, or health insurance claims
Strong understanding of coding standards (ICD-10, CPT), claims processing, and insurance guidelines
Excellent communication and negotiation skills
Proficiency with medical billing software and EMR systems
Detail-oriented, organized, and adaptable in a dynamic environment

Job Responsibility

Review insurance denial notifications and conduct thorough research to resolve outstanding claims issues
Analyze denial patterns and root causes, recommending process enhancements to prevent future occurrences
Communicate directly with insurance payers to troubleshoot and expedite claim resolutions
Prepare, document, and submit appeals for denied claims
Work closely with billing teams, healthcare providers, and insurance companies to ensure smooth claims management
Stay informed on payer guidelines and current healthcare compliance regulations
Consistently maintain adherence to HIPAA requirements and internal policies

What we offer

medical, vision, dental, and life and disability insurance
company 401(k) plan
free online training

Medical Insurance Claims Specialist

We are looking for a detail-oriented Medical Insurance Claims Specialist to join...

Location

United States , Spokane

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical billing, claims processing, or insurance-related roles
Familiarity with third-party payer systems and medical billing procedures
Strong knowledge of patient and insurance eligibility verification processes
Proficiency in handling insurance claims and resolving issues related to denials or discrepancies
Exceptional attention to detail and accuracy in managing financial transactions
Excellent communication skills for interacting with patients and insurance providers
Ability to work independently while adhering to established procedures and deadlines

Job Responsibility

Process medical claims for third-party payers and rebill as necessary to ensure accurate submission
Investigate unpaid claims, determine payment status, and take corrective action by appealing denials or resubmitting claims
Communicate with insurance providers to resolve discrepancies in payments or unpaid services
Identify and correct errors in claim information to ensure successful submissions
Assist patients with understanding their insurance claims and address their basic billing concerns
Provide support for patient collection inquiries during the absence of the Collections Specialist
Authorize write-offs for uncollectible balances within designated authority limits
Research and resolve credit balances, issuing refunds to the appropriate parties as necessary
Complete assigned special projects and additional tasks as required

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Medical Claims Specialist

We are looking for a dedicated Medical Claims Specialist to join our healthcare ...

Location

United States , Federal Way

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical collections, claims resolution, or revenue cycle management
Strong ability to interpret insurance contracts, documents, and regulatory guidelines
Knowledge of benefit verification and authorization processes within healthcare
Analytical skills to identify and address root causes of claim denials effectively
Reliable high-speed internet and familiarity with secure remote work systems
Proficiency in video conferencing and adherence to remote communication protocols
High level of responsiveness, urgency, and accountability in managing tasks
Ability to work exclusively for the organization without concurrent external roles

Job Responsibility

Conduct detailed benefit verification for patient insurance coverage to ensure accurate claims submission
Investigate and resolve unpaid or denied claims by analyzing root causes and utilizing available resources
Communicate effectively with insurance payers to address claim issues and facilitate timely payment
Interpret insurance contracts and regulations, ensuring compliance with state and employer-specific requirements
Participate in virtual meetings promptly, adhering to meticulous standards and security protocols
Utilize secure systems to manage sensitive data in a remote environment
Verify insurance authorizations and approvals accurately to support seamless claim processing
Collaborate with team members to resolve complex payment barriers and ensure smooth operations
Manage and resolve a set number of complex accounts daily, meeting productivity expectations
Respond promptly to supervisor and leadership inquiries during work hours, maintaining a high level of accountability

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

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Claims and Denials Specialist

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