Medical Claims Analyst Job at Robert Half (Cincinnati)

Medical Claims Analyst

We are looking for a Medical Claims Analyst to support leave and medical claims ...

Location

United States , Minneapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of experience handling medical claims, leave administration, or related insurance benefits work
Demonstrated ability to review leave requests and medical leave documentation with a high level of accuracy
Experience calculating benefit payments and interpreting coverage or eligibility guidelines
Familiarity with claim decision-making, including approvals, denials, and resolution of rejected claims
Working knowledge of unemployment, medical, or insurance-related claims processes is preferred
Hands-on experience using Workday HCM and the ServiceNow platform in a claims or case management environment
Strong organizational skills with the ability to manage a queue-based workload and meet time-sensitive deadlines

Job Responsibility

Manage a daily workload of upcoming leave cases, ensuring each request is reviewed promptly and moved through the claims process efficiently
Obtain and evaluate medical documentation from healthcare providers to confirm eligibility and support leave determinations
Calculate benefit amounts and determine the appropriate financial responsibility between employer-sponsored programs and applicable state benefits
Examine leave and medical claims thoroughly to make informed approval or denial decisions based on documentation and policy guidelines
Maintain accurate claim records and status updates within ServiceNow and Workday to support visibility and compliance
Respond to issues involving incomplete, disputed, or rejected claims by investigating details and coordinating next steps
Partner with internal stakeholders and benefits-related teams to resolve claim questions and maintain smooth leave administration
Monitor claim activity for adherence to established procedures, deadlines, and documentation standards

What we offer

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

Medical Claims Analyst

We are looking for a Medical Claims Analyst to join our team in Raleigh, North C...

Location

United States , Raleigh

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2–5 years of experience in Medicaid, medical claims, healthcare auditing, or a closely related field
Working knowledge of Medicaid claims processing, medical billing, denials management, and rejected claims review
Experience conducting audit testing, provider reviews, or payment validation activities within a healthcare environment
Ability to interpret regulatory requirements and apply them accurately to audits, claim reviews, and documentation
Strong analytical skills with the ability to identify variances, research issues, and present clear findings
Effective written documentation skills for preparing audit support materials, findings, and review summaries
Proficiency in handling sensitive healthcare information with a high level of accuracy, organization, and professionalism

Job Responsibility

Review provider records and claims activity to assess payment accuracy and identify discrepancies requiring follow-up
Perform audit procedures tied to Medicaid claims, billing practices, denials, and rejected claims to support program integrity efforts
Interpret Medicaid rules and applicable federal guidance when evaluating findings and determining compliance outcomes
Prepare organized workpapers, summaries, and preliminary reports that clearly document testing results and supporting analysis
Investigate claim issues and collaborate with stakeholders to address exceptions, recommend corrective actions, and support resolution plans
Analyze medical billing and reimbursement data to detect trends, payment concerns, and areas of potential financial risk
Support compliance reviews involving provider activity, claim adjudication, and payment validation across assigned cases

What we offer

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

Fulltime

Medical Claims Analyst

We are looking for a detail-oriented Medical Claims Analyst to join a team suppo...

Location

United States , Raleigh

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2–5 years of experience in Medicaid, healthcare claims, or audit-related roles
Hands-on knowledge of medical claims processing, claim denials, rejected claims, and medical billing practices
Familiarity with Medicaid billing requirements and provider-focused audit or program integrity work
Ability to evaluate documentation, perform testing, and apply regulatory guidance to support sound conclusions
Strong analytical skills with the ability to organize findings and maintain thorough audit records
Effective written and verbal communication skills for presenting issues and collaborating with cross-functional teams
Proficiency in reviewing claim data and identifying inconsistencies, risks, or compliance concerns

Job Responsibility

Review provider billing records and medical claim activity to identify discrepancies, validate payments, and assess adherence to Medicaid guidelines
Carry out structured audit procedures for claims, denials, rejected claims, and billing documentation to support program integrity efforts
Interpret applicable Medicaid requirements and federal regulatory standards when analyzing audit results and determining potential issues
Develop clear working papers, summaries, and preliminary findings that accurately document testing performed and conclusions reached
Partner with internal stakeholders to clarify claim exceptions, address audit questions, and support corrective action recommendations
Analyze medical billing and Medicaid claim data to detect patterns, trends, and areas requiring additional review
Contribute to compliance examinations involving provider assessments, payment verification, and operational claim review activities

What we offer

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

Fulltime

Epic Professional Billing Claims Analyst

As an IT EPIC Application Analyst, you will implement, optimize, and support our...

Location

United States , Englewood

Salary:

43.20 - 64.26 USD / Hour

American Nursing Care

Expiration Date

Until further notice

Requirements

Bachelors Other in a related field or 4 years of equivalent experience may be considered in lieu of Bachelor's degree, upon hire
2 years of relevant experience in one of the following areas: Clinical, operational, application support and implementation
Epic Professional Billing certification and/or experience required
Development experience with applications in a hospital or medical related industry is required
Experience working with project life cycle or project management methodologies is required
EPIC Certification, within 120 Days

Job Responsibility

Designs, builds, tests, implements, and supports information technology solutions to meet operational and clinical needs
Responsible for delivering project assignments of medium to high complexity which includes application design, and configuration build
Works closely with customers to document requirements and communicate effectively with customers and peers to implement changes
Supports/maintains day-to-day existing functionality/programs/applications
Performs intermediate system analysis and troubleshooting to implement new functionality/programs/applications, and to analyze/research vendor release notes and documentation
understanding complete end-to-end system integration
Creates thorough system design and build documentation
Analyze the functionality of the system and how it fits or not with operations
The ability to troubleshoot basic problems and recommend and take appropriate action as required
Translate high-level business requirements to detailed technical designs/documentation

What we offer

medical
prescription drug
dental
vision plans
life insurance
paid time off (full-time benefit eligible team members may receive a minimum of 14 paid time off days, including holidays annually)
tuition reimbursement
retirement plan benefit(s) including, but not limited to, 401(k), 403(b), and other defined benefits offerings

Fulltime

Claims Services Processing Analyst with Italian

This opportunity offers a chance to grow within a global, diverse, and inclusive...

Location

Poland , Krakow

Salary:

Not provided

Aon

Expiration Date

Until further notice

Requirements

Education or interest in insurance, healthcare, administration, or related fields
Previous experience in documentation validation, data entry, claims processing, or administrative support is a plus but not required
Good attention to detail and a genuine willingness to learn new processes and systems
Basic analytical and organizational skills with a structured approach to tasks
Comfort working with IT systems and data
A collaborative, can-do attitude with motivation to develop and grow within the team
Fluency in English and Italian (at least C1) is required

Job Responsibility

Manage medical expense reimbursement requests across different reimbursement scenarios
Receive, review, and validate medical and administrative documentation submitted by beneficiaries
Assess eligibility and calculate payable reimbursement amounts based on policy terms
Request additional or corrective documentation when needed to progress cases
Maintain accurate claim records and keep systems up to date
Coordinate with internal teams to support smooth and efficient case handling
Ensure timely completion and closure of all assigned medical claims

What we offer

Access to continuous learning and professional development opportunities
Supportive team environment
Competitive benefits package
Flexible working arrangements
Two Global Wellbeing Days each year

Fulltime

New

Medicaid Pricer Regulatory Analyst

Location

India , Hyderabad

Salary:

Not provided

Zelis

Expiration Date

July 31, 2026

Requirements

Interest in developing knowledge of reimbursement methodologies and applicable regulatory frameworks
Strong attention to detail with the ability to accurately interpret written material
Effective written and verbal communication skills with the ability to convey information clearly and concisely
Strong multitasking and time-management skills in deadline-driven environments
Strong critical thinking skills to evaluate issues, identify solutions, and support data-driven decision-making
Working knowledge of Microsoft Excel with experience using formulas, lookups, and data comparison tools
Working knowledge of public and private healthcare payment systems, medical claims, standard claim coding, claim editing, contracting, and provider networks
Working knowledge of MS SQL Server Studio a plus
4 years of relevant experience or equivalent combination of education & work within healthcare payer or provider
Knowledge of healthcare reimbursement methodologies, claim coding and acceptable billing practices

Job Responsibility

Perform basic research on Medicaid regulations, state bulletins, and published fee schedules under the guidance of senior team members
Summarize regulatory findings and assist in interpreting requirements for internal use
Assist in maintaining pricing logic and configuration by performing routine updates and data entry tasks
Help draft or update procedural documentation, SOPs, and reference materials
Contribute to the creation of user story components (e.g., requirements outlines, rule summaries)
Use Excel or internal tools to conduct comparisons, calculations, and data-driven validation
Support the preparation of sample claims and expected outcomes for testing and QA
Participate in system testing by executing test cases and documenting results
Assist in identifying potential issues or discrepancies in pricing outputs and escalating to senior analysts
Collaborate with internal teams—including Development, QA, and Client Services—to clarify questions and support project work

Fulltime

Analyst- Analytics and Data Science II-III (Remote)

Provide strategic analysis that impacts business decisions, improves efficiency ...

Location

United States , Phoenix

Salary:

Not provided

Blue Cross Blue Shield of Arizona

Expiration Date

Until further notice

Requirements

Bachelor's Degree in mathematics, statistics, business, or related field of study
1 year of experience in data analysis using analytic tools and processes (Level 1)
3 years of experience in data analysis using analytic tools and processes (Level 2)
3 years of experience working for a healthcare organization/heath insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 3)
5 years of experience working for a healthcare organization/heath insurer in data analysis using analytic tools and processes using advanced SAS procedures and/or data mining (Level 4)

Job Responsibility

Provide strategic analysis that impacts business decisions, improves efficiency and drives innovation
Perform data extraction, healthcare cost analysis, analytical model development, as well as production of various reports to support corporate strategies and initiatives
Execute complex analyses that guide the development of reimbursement policy, provider negotiations, network development, value-based care, population health management, utilization management programs and other medical cost containment solutions
Provide accurate, timely and reliable delivery of data, metrics, reporting and analysis in support of multiple strategic goals, mandates, and legislation
Develop processes, write programs and/or create databases using analytic tools to produce accurate and timely completion of analytic solutions
Identify, analyze, interpret and validate healthcare data metrics, trends and patterns
Develop and analyze business performance reports (e.g. for claims data, provider data, utilization data) and provide notations of performance deviations and anomalies
Model financial impact analyses for a variety of business initiatives
Partner with peers to establish, evaluate, and continually improve measurement methodologies, while adhering to nationally accepted analytic and reporting standards
Act as liaison to both internal business partners and external providers or vendors

Fulltime

Revenue Cycle Analyst

We are looking for a Revenue Cycle Analyst to support healthcare revenue operati...

Location

United States , Chattanooga

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience working in healthcare revenue cycle, medical billing, or medical claims environments
Strong proficiency in Microsoft Excel, including pivot tables, data analysis, and report preparation
Ability to interpret complex datasets and deliver meaningful analytical insights
Understanding of revenue cycle processes and common billing-related performance measures
Solid critical thinking skills with a detail-oriented approach to problem solving
Comfort working within structured system access requirements, training steps, and compliance-driven workflows
Ability to manage recurring monthly deliverables while maintaining accuracy and consistency

Job Responsibility

Produce recurring reports that track provider performance, productivity trends, and comparative metrics across accounts
Extract patient and account-level data from designated systems and prepare it for routine analysis and reporting needs
Build and maintain Excel-based analyses, including advanced data organization, summarization, and pivot table reporting
Review billing and claims information to identify patterns, variances, and opportunities for improved revenue cycle performance
Translate raw operational data into practical insights that support decision-making for revenue cycle stakeholders
Complete required system access steps, assessments, and training modules to obtain authorization for relevant platforms such as Epic
Follow established workflows and documentation standards when navigating systems and handling reporting tasks
Partner with internal teams to ensure reporting outputs are accurate, timely, and aligned with business requirements

What we offer

Medical insurance
Vision insurance
Dental insurance
Life and disability insurance
401(k) plan

Fulltime

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Medical Claims Analyst

Job Description

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