CrawlJobs Logo

Medical Claims Analyst

https://www.roberthalf.com Logo

Robert Half

Location Icon

Location:
United States , Raleigh

Category Icon
Category:
IT - Administration

Job Type Icon

Contract Type:
Not provided

Salary Icon

Salary:

Not provided
Save Job
Save Icon
Apply Position

Job Description:

We are looking for a detail-oriented Medical Claims Analyst to join a team supporting Medicaid audit and claims review activities in Raleigh, North Carolina. This contract opportunity is ideal for someone who can evaluate provider billing practices, examine payment accuracy, and contribute to compliance-focused reviews with growing independence. The role offers the chance to apply analytical judgment, strengthen audit documentation, and help improve the integrity of Medicaid-related claims operations.

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

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
What we offer:
  • medical
  • vision
  • dental
  • life and disability insurance
  • 401(k) plan

Additional Information:

Job Posted:
May 03, 2026

Employment Type:
Fulltime
Work Type:
On-site work
Icon
Robert Half - All Job Offers
Job Link Share:
Copy Link Icon
Facebook Icon Twitter Icon LinkedIn Icon

Looking for more opportunities? Search for other job offers that match your skills and interests.

Briefcase Icon

Similar Jobs for Medical Claims Analyst

Senior Associate Medical Data Analyst

The Senior Associate Medical Data Analyst will play a pivotal role in supporting...
Location
Location
India , Hyderabad
Salary
Salary:
Not provided
amgen.com Logo
Amgen
Expiration Date
Until further notice
Flip Icon
Requirements
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
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
Read More
Arrow Right
New

Medical Claims Analyst

We are looking for a Medical Claims Analyst to join our team in Raleigh, North C...
Location
Location
United States , Raleigh
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
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
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
What we offer
  • medical insurance
  • vision insurance
  • dental insurance
  • life insurance
  • disability insurance
  • 401(k) plan
  • Fulltime
Read More
Arrow Right

Medical Claims Analyst

We are looking for a detail-oriented Medical Claims Analyst to join our team in ...
Location
Location
United States , Cincinnati
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
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
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
What we offer
  • medical, vision, dental, and life and disability insurance
  • company 401(k) plan
Read More
Arrow Right

Medical Claims Analyst

We are looking for a skilled Medical Claims Analyst to join our team in Baton Ro...
Location
Location
United States , Baton Rouge
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Minimum of 3–5 years of experience in medical claims and denials, with a strong focus on Medicare
  • Proficiency in using medical billing systems, with Epic EMR experience preferred
  • Familiarity with healthcare audits, including Medicare and Medicaid
  • Expertise in handling rejected claims and navigating claim denial processes
  • Strong communication skills and the ability to provide clear guidance to team members
  • Detail-oriented with excellent organizational and problem-solving abilities
  • Demonstrated ability to work independently and take initiative in resolving claim issues
Job Responsibility
Job Responsibility
  • Analyze and manage Medicare claims and denials, ensuring accuracy and compliance
  • Provide support to staff by addressing questions related to claims and denial processes
  • Conduct thorough follow-up on denials, including contacting payers to identify reasons for rejection
  • Submit required documentation or medical records to facilitate claim resolution
  • Perform detailed research and gather information to resolve complex claim issues
  • Utilize the Medicare portal effectively to track and resolve claims
  • Maintain comprehensive documentation of claim activities and ensure timely follow-up
  • Collaborate with team members to improve processes and minimize claim denials
What we offer
What we offer
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan
  • free online training
Read More
Arrow Right

Siu Senior Analyst, Lead Investigator

We’re building a world of health around every individual — shaping a more connec...
Location
Location
United States
Salary
Salary:
46988.00 - 112200.00 USD / Year
https://www.cvshealth.com/ Logo
CVS Health
Expiration Date
May 11, 2026
Flip Icon
Requirements
Requirements
  • Must reside in Maryland
  • 5+ years of claim data interpretation and analysis experience
  • Solid understanding of medical and pharmaceutical claim data, medical claims coding (CPT/HCPCS/ICD/NDC)
  • Advanced analytical and research skills, with the ability to independently identify and source information
  • Advanced experience with Excel
  • Healthcare Insurance background
  • Excellent verbal and written communication skills
  • Experience with healthcare coding
  • Must be able to travel to provide testimony if needed
Job Responsibility
Job Responsibility
  • Validation of existing Fraud, Waste and Abuse business rules/leads designed to detect aberrant billing patterns as reviewing incoming referrals
  • Research and ad hoc report development to identify fraud, waste and abuse schemes and trends
  • Review company clinical & payment policies to determine the impact of the scheme on Aetna business
  • Identify all possible issues related to fraud, waste and abuse when reviewing a new lead or referral
  • Keep current with new & emerging fraud, waste and abuse schemes and trends through training sessions and industry resources
  • Interpret, analyze and present key findings to internal customers (project team, investigators) providing recommendations based on analytical findings
What we offer
What we offer
  • Medical, dental, and vision coverage
  • paid time off
  • retirement savings options
  • wellness programs
  • other resources
  • Fulltime
!
Read More
Arrow Right

Qa analyst

The QA Analyst role focuses on validating AI-enabled insurance claims processing...
Location
Location
India , Bangalor
Salary
Salary:
Not provided
nttdata.com Logo
NTT DATA
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Insurance claims processing or medical billing background
  • Experience performing structured QA or validation reviews
  • Familiarity with hospital billing artifacts (UB-04s, itemized bills) preferred
  • Strong attention to detail and ability to identify patterns
Job Responsibility
Job Responsibility
  • Review AI-generated claim summaries and extracted data against source documents (UB-04s, itemized bills, claim forms, medical records)
  • Validate accuracy of adjudication-relevant fields (admission/discharge dates, confinement status, diagnosis and revenue codes, level of care)
  • Identify missing, incorrect, or conflicting data that may impact claim processing
  • Document QA findings in a structured format and flag recurring/systemic issues
  • Support regression testing by comparing outputs from new releases against prior versions and noting improvements or regressions
Read More
Arrow Right

Revenue Cycle Analyst

This is a long-term contract position where you will play a key role in managing...
Location
Location
United States , Jacksonville
Salary
Salary:
Not provided
https://www.roberthalf.com Logo
Robert Half
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Proven experience in healthcare revenue cycle management, including billing and claims
  • Strong understanding of medical billing processes and regulatory compliance
  • Familiarity with revenue cycle systems, especially MedSeries4 (MS4)
  • Ability to analyze data and identify trends impacting revenue operations
  • Excellent organizational and communication skills
  • Experience in supply chain processes within healthcare settings is preferred
  • Detail-oriented with the ability to manage multiple tasks effectively
  • Proficiency in relevant software and tools for revenue cycle operations
Job Responsibility
Job Responsibility
  • Analyze and evaluate healthcare revenue cycle processes to identify areas for improvement
  • Oversee medical billing operations, ensuring accuracy and compliance with industry standards
  • Process and manage medical claims efficiently to optimize revenue collection
  • Collaborate with teams to implement strategies for streamlining billing functions
  • Utilize MedSeries4 (MS4) systems to support revenue cycle tasks and reporting
  • Monitor key performance metrics related to revenue cycle activities and provide actionable insights
  • Assist in transitioning revenue cycle functions as needed to improve efficiency
  • Maintain up-to-date knowledge of healthcare regulations and billing requirements
  • Provide support and guidance to teams on revenue cycle best practices
  • Resolve discrepancies or issues related to claims and billing processes
What we offer
What we offer
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan
Read More
Arrow Right

Prescription Plan Design Escalations Analyst

Responsible for internal and external functions that support accurate claim proc...
Location
Location
United States , Phoenix
Salary
Salary:
Not provided
azblue.com Logo
Blue Cross Blue Shield of Arizona
Expiration Date
Until further notice
Flip Icon
Requirements
Requirements
  • Experience in pharmacy or medical field (Level 1 – 3 years
  • Levels 2 and 3 – 5 years
  • Level 4 – 6 years)
  • Experience in prescription benefit administration (Level 1 – 1 year
  • Level 2 - 3 years
  • Level 3 – 5 years
  • Level 4 – 6 years)
  • Experience working in vendor applications (rebate, web tools, formulary tools) (Level 2 – 1 year
  • Level 3 – 2 years
  • Level 4 – 5 years)
Job Responsibility
Job Responsibility
  • Analyze PBM prescription claim and other applicable systems for medication benefit quality and accuracy
  • Support internal and external customers with information on benefits applicable to medication claims
  • Perform, evaluate, and assist in defining and improving the quality, quantity and timeliness standards to achieve individual and department performance goals as defined within the department guidelines
  • Administer, interpret, and maintain current working knowledge of required BCBSAZ systems, procedures, forms and manuals
  • Communicate recommendations in regard to medication claim processing and benefit decisions
  • Monitor and investigate reported plan set up system issues
  • Participates in quality initiatives
  • including functions that support audits, reporting, evaluation of quality opportunities and concerns, and creation and implementation of corrective actions as requested
  • Resolve escalated member issues
  • Research & provide recommendations for accumulations issues
  • Fulltime
Read More
Arrow Right