Medical Claims Analyst Job at Robert Half (Minneapolis)

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

Medical Claims Analyst

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

Location

United States , Cincinnati

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

3+ years of medical claims adjudication experience in a self‑funded health plan environment
Direct experience supporting union, Taft‑Hartley, or collectively bargained benefit plans
Strong knowledge of medical terminology, CPT, HCPCS, and ICD‑10 codes
Solid understanding of ERISA and self‑funded plan administration
Experience interpreting plan documents and SPD language
Proficiency with claims systems and Microsoft Office (Excel, Word, Outlook)
Strong analytical, problem‑solving, and attention‑to‑detail skills
Excellent written and verbal communication skills

Job Responsibility

Review, analyze, and adjudicate medical claims for a self‑funded union health plan in accordance with plan documents, SPD, and collective bargaining agreements
Interpret benefits, eligibility, coverage limits, and exclusions to ensure accurate claim determination
Apply applicable fee schedules, contracts, and network guidelines
Identify and resolve claim discrepancies, overpayments, coordination of benefits (COB), subrogation, and eligibility issues
Research, process, and respond to participant, provider, and union inquiries regarding claim status and benefit interpretation
Prepare written explanations of benefits (EOBs) and appeal decisions with clear, compliant documentation
Assist with first‑ and second‑level appeals, audits, and regulatory requests
Ensure compliance with ERISA, HIPAA, ACA, and other applicable regulations
Collaborate with internal teams, trustees, TPAs, stop‑loss carriers, and network vendors as needed
Maintain accurate claim documentation and meet established productivity and quality standards

What we offer

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

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

Senior Associate Medical Data Analyst

The Senior Associate Medical Data Analyst will play a pivotal role in supporting...

Location

India , Hyderabad

Salary:

Not provided

Amgen

Expiration Date

Until further notice

Requirements

PhD in Computer Science, Engineering, Mathematics, Healthcare or a related field and 1+ year(s) of Medical Data Analytics, Commercial Data Analytics, Primary Market Research, Performance Reporting or related experience
Master’s degree in Computer Science, Engineering, Mathematics, Healthcare or a related field and 3+ years of Medical Data Analytics, Commercial Data Analytics, Market Research, Performance Reporting or related experience
Bachelor’s degree in Computer Science, Engineering, Mathematics, Healthcare or a related field and 5+ years of Medical Data Analytics, Commercial Data Analytics, Market Research, Performance Reporting or related experience

Job Responsibility

Translate complex analytical findings into clear, data-driven recommendations that enhance MSL engagement strategies and contribute to improved patient outcomes
Conduct data analysis across structured and unstructured datasets including but not limited to HCP sentiment, scientific engagement data, and publications
Design, develop, and maintain dashboards, reports, and visualizations to track performance, measure outcomes, and identify actionable trends using Python, R, SQL, Tableau, Power BI, or similar platforms
Understand pharmaceutical ecosystem and data sets including prescription (ex. IQVIA NPA), outlet (ex. IQVIA DDD), Lab as well as medical and pharmacy claims (ex. Symphony Claims.)
Establish and track KPIs to assess analytics impact and ensure alignment with business goals
Develop and deliver ad hoc data analyses that distill complex medical data into clear, actionable insights for stakeholders
Develop reusable code components, templates, and frameworks to support analytics scalability and lifecycle management
Collaborate with data science, IT, engineering, and external partners to ensure data access, integrity, governance, and seamless integration across platforms and systems
Contribute to Agile development workflows by collaborating in sprint planning, refining user stories, and delivering iterative analytics solutions aligned with business priorities
Continuously evaluate and introduce advanced techniques in visualization, predictive analytics, and automation

Medical Revenue Cycle Analyst

A National Healthcare Organization is in the need of a Medical Revenue Cycle Ana...

Location

United States , Los Angeles

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

strong analytical skills
healthcare billing knowledge
ability to collaborate across departments
working knowledge of Epic Software
CPC or CCS license is a plus

Job Responsibility

Perform data analysis to identify trends, issues, and opportunities for improvement within the revenue cycle processes, including billing, coding, collections, and reimbursements
Maintain and analyze financial and operational performance metrics related to claims processing, denial management, and payment posting
Collaborate with cross-functional teams, such as billing and collections, to streamline processes and improve revenue cycle operations
Research industry regulations and payer policies to ensure compliance and optimize reimbursements
Provide regular reporting to department leaders on revenue cycle performance, including key performance indicators (KPIs)
Support system upgrades and technology implementation to enhance revenue cycle efficiency
Identify and resolve discrepancies in payments or coding to reduce denials and delays in reimbursements
Conduct root cause analysis for claim denials and develop strategies for resolution
Participate in budgeting and forecasting to align revenue cycle goals with financial strategies

What we offer

competitive compensation and benefits
free online training
medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

New

Senior Litigation Analyst

Under the direction of the Vice President and Deputy General Counsel, this posit...

Location

United States , Shaker Heights

Salary:

71739.00 - 112195.00 USD / Year

University Hospitals

Expiration Date

Until further notice

Requirements

10+ years Of litigation paralegal, claims and/or risk management experience in a law firm or corporate legal environment.
Large firm or corporation litigation paralegal experience strongly
Experience with data analysis
Ability to work independently with sound judgment and excellent organizational skills.
Effective negotiation skills and strategies.
Well-developed verbal/written communication, analytical and interpersonal skills
Knowledge of e-discovery also a plus.
Legal & medical terminology, trial proceedings and applicable federal, state & local laws, and investigative skills.
Proficient in Microsoft Office Suite and Internet-based research.
Paralegal certificate with substantial legal support experience

Job Responsibility

Negotiate with patients/visitors and/or attorneys to settle medical malpractice and general liability claims
has independent settlement authority up to $5,000.00.
Work independently and/or with assistance of in-house and outside counsel on employment, compliance, and government investigations
use discretion in identifying and interviewing witnesses
prepare investigative summaries
formulate recommendations
prepare legal holds
collect, review, and organize relevant documents.
Compile and analyze medical malpractice and employment claim data for benchmarking, trending, and physician/employee PIP/Corrective Action purposes.
Train and educate employees, office and physician staff

What we offer

Healthcare
dental
vision
retirement plan options
additional offerings

Fulltime

New

Revenue Cycle Analyst

Location

United States , Oak

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in healthcare administration, customer support, medical billing, claims processing, or data entry is preferred
Working knowledge of revenue cycle functions, medical claims, billing activities, or accounts receivable processes
Strong attention to detail with the ability to identify errors and maintain accurate records
Comfort using computers and learning internal systems and workflows quickly
Effective written and verbal communication skills for coordination with internal teams
Strong organizational skills with the ability to manage multiple priorities in a deadline-driven environment
Dependable attendance and availability to fulfill the full contract assignment onsite

Job Responsibility

Examine claim records carefully and correct incomplete, inaccurate, or inconsistent information to support proper processing
Input, update, and maintain claim and account details within internal platforms with a high degree of accuracy
Investigate missing documentation or data issues and take appropriate steps to resolve outstanding items
Assist with account review activities, document validation, and follow-up tasks tied to revenue cycle operations
Communicate clearly with internal departments to clarify information and keep claim-related work moving forward
Maintain organized records and complete assigned deliverables within established deadlines
Provide administrative and data-processing support for billing, claims, and accounts receivable workflows

What we offer

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

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Medical Claims Analyst

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