Claims Processing Specialist Job at Robert Half (Honolulu)

Mechanical Claims Processing Specialist

Our client, a rapidly growing automotive service contract administration company...

Location

United States , Austin

Salary:

20.00 - 21.00 USD / Hour

Beacon Hill

Expiration Date

Until further notice

Requirements

Previous experience as a Warranty Administrator, Automotive Service Advisor, or similar role preferred
Familiarity with vehicle service contracts and mechanical claims processes
Experience handling financial transactions, invoice verification, and payment reconciliation
Ability to read and understand contractual language and automotive repair terminology
Ability to interpret automotive service invoices and repair orders
Proficiency in Microsoft Office Suite (Excel, Outlook, Word)
Strong verbal and written communication skills
High attention to detail and accuracy
Ability to maintain assigned production levels

Job Responsibility

Review, upload, and organize mechanical claims-related documents within internal systems
Review service invoices and repair orders for accuracy and completeness prior to payment processing
Process claims payments accurately and in a timely manner
Perform accurate data entry and maintain claims records
Monitor workflows to ensure claims and documentation are processed within required timelines
Coordinate with Claims Examiners on open or pending claims to resolve outstanding issues
Communicate professionally with internal teams and external partners regarding claim status and updates

Fulltime

Claims Specialist

Do you have the analytical eye of a detective and the natural empathy of a maste...

Location

Canada , Mont-Saint-Grégoire

Salary:

Not provided

Randstad

Expiration Date

August 01, 2026

Requirements

1 to 3 years of proven success in a role demanding rigorous problem-solving (e.g., corporate customer care, claims handling, insurance, logistics, or a related field)
Highly comfortable navigating digital environments, including the MS Office Suite (Excel) and enterprise CRM/ERP systems
You are highly autonomous and self-motivated, yet you fundamentally understand that the biggest wins are achieved as a team
Fluent Bilingualism (French/English): Exceptional written and verbal communication skills in both languages are essential, as you will interact daily with clients and partners across Canada and the United States

Job Responsibility

Lead the Investigation (Analysis & Diagnosis): Meticulously analyze and cross-reference vehicle inspection reports (including before-and-after photos, GPS data, and driver logs) to verify the validity and origin of transit damage claims
Be the Ambassador of Solutions: Take full ownership of claims submitted by private clients and dealership partners. Guide them through the process with empathy, transparency, and clear communication
Masterful Negotiation: Evaluate repair estimates from body shops, determine financial settlements, and negotiate fair, cost-effective agreements in line with corporate guidelines
Collaborate for Prevention: Partner closely with dispatch teams and drivers to document incidents accurately and proactively suggest operational improvements to minimize future risks
Administrative Excellence: Maintain an impeccably organized internal CRM system, ensuring every claim file is thoroughly documented, clear, and up to date

What we offer

weekly pay
access to comprehensive benefits from week one
Guaranteed Work-Life Balance: A fixed daytime schedule from Monday to Friday. Your evenings and weekends belong entirely to you
free on-site parking

Fulltime

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

Claims Specialist

We are looking for a Claims Specialist to join a growing legal and risk team in ...

Location

United States , Chesterfield

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of experience managing workers’ compensation, auto liability, and/or general liability claims
Working knowledge of employer-side workers’ compensation administration and related claim practices
Experience coordinating with third-party administrators, insurers, and external legal counsel
Ability to manage a large and active claim inventory with strong attention to detail, documentation quality, and follow-through
Strong communication skills and the ability to work effectively with stakeholders across multiple departments and organizational levels
Proficiency with claims management systems and Microsoft Office applications.

Job Responsibility

Oversee claims from initial notice through final resolution, ensuring each case is documented thoroughly and advanced in a timely manner
Manage a varied caseload with significant emphasis on workers’ compensation matters, along with auto liability and general liability exposures
Work closely with third-party administrators, insurance carriers, and outside counsel to support effective claim handling and informed decision-making
Gather, review, and organize records such as wage information, incident details, and related supporting materials needed for evaluation and processing
Submit and track claims in alignment with company standards and applicable regulatory obligations, maintaining accuracy throughout the process
Partner with teams across operations, human resources, legal, and safety to collect facts, resolve open issues, and move claims toward closure
Monitor milestones, deadlines, reserves, settlement discussions, and litigation-related developments in collaboration with the Claims Manager
Maintain secure, well-ordered claim files while protecting confidential information and supporting process improvements in a high-volume, evolving organization.

What we offer

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

Processing Specialist

We’re excited to partner with a client in West Des Moines, Iowa to add a Process...

Location

United States , West Des Moines

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 1 year of experience in an administrative role
Proficiency in data entry and strong computer skills, including the ability to work in multiple systems at once
Ability to adapt to changing processes, shifting priorities, and evolving daily work demands
Experience supporting claims processing, customer service activities, or related transactional work is preferred
Familiarity with database-driven web applications and general office technology tools

Job Responsibility

Enter, update, and verify information across several computer-based systems while maintaining a high level of accuracy
Support claims-related and project processing tasks by reviewing records, completing data entry, and following established procedures
Monitor assigned work items closely to ensure timely completion and proper documentation
Communicate clearly and professionally in writing and verbally when coordinating with team members and other departments
Adjust quickly to changing priorities, workflows, and daily assignments in a dynamic support environment
Navigate database-driven web applications efficiently to complete routine and time-sensitive tasks

What we offer

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

Pharmacy Assistant - ODB and Private Payor Insurance Claims Specialist

Are you an experienced Pharmacy Assistant looking for a long-term career outside...

Location

Canada , Burlington

Salary:

50000.00 - 55000.00 CAD / Year ▼

Randstad

Expiration Date

July 30, 2026

Requirements

1+ years of pharmacy experience in a mid-to-high volume pharmacy setting (ideally Kroll-based - must have strong data entry / intake / insurance claim experience!)
Professional phone manner and ability to manage incoming and outgoing calls while typing at 50 WPM+
Strong working knowledge of Kroll prescription software - we are open to applicants with other software background who also possess strong MS Office skills
Proficient in Microsoft Office tools (Word, Excel, Outlook, Teams)
Excellent attention to detail, time management, and organizational skills
Comfortable working in a high-volume, structured team environment
Eager to learn and grow with a company that values your pharmacy expertise
Available to start ASAP (if you are working in a permanent role, your requirement for a 2-3 week notice period will certainly be respected, if hired)

Job Responsibility

Enter prescriptions in Kroll with accuracy and efficiency
Complete third party billing and adjudication through public and private providers, calling providers to resolve problems and understand issues
Support the prescription filling process by picking, labeling, and preparing medications
Communicate internally via email/Teams and assist with coordination of deliveries
Assist with pharmacy inventory: receiving, stocking, and tracking medications
Prepare and verify waybills and shipping details for outbound prescription deliveries
Collaborate with pharmacy technicians and pharmacists in a fast-paced, team setting
Maintain pharmacy records and assist with general housekeeping or administrative duties

What we offer

Full benefits package starting from day one
Annual Bonus Potential
3 weeks of vacation per calendar year
wellness days
paid and unpaid sick days
Retirement Program with attractive matching from the employer
Stock Purchase Program
Annual Merit Program
Career Growth opportunities

Fulltime

Bilingual Claims Processing Specialists

We are seeking Claims Processing Specialists (Independent Contractors) to suppor...

Location

Canada , Montréal

Salary:

23.00 USD / Hour

Randstad

Expiration Date

July 25, 2026

Requirements

Bilingualism (English and French) is required to communicate regularly with clients located outside Quebec
1+ year of experience in phone support (an asset)
Prior experience in data entry and administrative roles
Experience in claims, insurance, or complaints management
Proficiency in the Microsoft 365 suite (Outlook, Word, and Excel)
Familiarity with case management software and databases
Experience with VoIP/Internet phone services is desirable
Exceptional attention to detail
Commitment to high-quality deliverables
Self-motivated

Job Responsibility

Managing Correspondence: Handle incoming and outgoing mail, email, faxes, and phone communications
Ensure call & claims are processed promptly and directed appropriately
Data Entry & Verification: Enter, review, and verify data from electronic and paper forms into a standard database, maintaining accuracy and confidentiality at all times
Document Processing & Organization: Scan, file, and securely store sensitive materials
Organize physical and digital records to ensure efficient retrieval when needed
Claims Coding & Quality Checks: Code claim details based on policy documentation, accurately capturing information
Conduct quality assurance and comply with internal and regulatory standards
Identify inconsistencies or red flags and raise them for investigation or review
Claimant Support & Communication: Maintain precision and attention to detail when processing claims, data and information
Return incoming calls in a professional and empathetic manner, & assisting claimants

What we offer

Contract Duration: 3-month renewable contract
Salary: $23 per hour

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

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Claims Processing Specialist

Job Description

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