Medical Claims Representative Job at Robert Half (Lincolnwood)

Medical Claims Representative

We are looking for a detail-oriented Medical Claims Representative to support he...

Location

United States , Lincolnwood

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Experience handling medical claims within a healthcare, hospital, or social assistance setting
Working knowledge of medical billing processes, insurance claim workflows, and claim administration practices
Ability to verify insurance information accurately and apply coverage details to claim processing activities
Strong attention to detail with the ability to identify errors, missing information, and claim inconsistencies
Effective written and verbal communication skills for coordinating with payers and internal teams
Proficiency in maintaining accurate documentation and managing multiple claims at different stages of review
Ability to work independently in a Contract role while meeting deadlines in a high-volume environment

Job Responsibility

Review incoming medical claims for completeness, accuracy, and alignment with payer requirements before submission or follow-up
Manage billing-related claim activity by researching discrepancies, correcting documentation issues, and helping move claims toward resolution
Verify medical insurance coverage and eligibility details to support proper claim handling and reduce preventable denials
Track claim status with insurance carriers, document updates clearly, and communicate next steps to relevant internal stakeholders
Investigate denied, rejected, or delayed claims and take appropriate action to support timely reconsideration or resubmission
Maintain organized claim administration records and ensure case details are updated accurately within designated systems
Work closely with billing, administrative, and healthcare support teams to address claim questions and improve turnaround times

What we offer

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

Fulltime

Medical Claims Representative

We are looking for a Medical Claims Representative to join our team in Pleasanto...

Location

United States , Pleasanton

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Prior experience in medical claims processing, claim administration, or medical billing is required
Bilingual fluency in English and Spanish is required for effective communication with members
Strong understanding of medical terminology and its application in billing or claims review
Knowledge of insurance verification, benefit structures, and healthcare-related policies and procedures
Ability to read and interpret billing codes, claim documents, and supporting records with accuracy
Basic proficiency in Microsoft Excel and confidence learning new claims or member information systems
Strong written and verbal communication skills with the ability to manage high-volume workloads effectively

Job Responsibility

Review, evaluate, and process medical claims with close attention to accuracy, completeness, and applicable coverage details
Enter and maintain member, enrollment, beneficiary, and medical information within internal claims systems while following established procedures
Verify insurance details and confirm benefit eligibility to support timely and correct claim handling
Interpret billing information, coding details, and supporting documentation to determine appropriate claim outcomes
Communicate with members, providers, and internal partners regarding claim status, required documentation, and benefit-related questions
Assist Spanish-speaking members by providing clear and thorough support in both English and Spanish
Apply working knowledge of healthcare benefits, policies, and regulatory guidelines when reviewing claim activity
Escalate complex or legally sensitive claim matters to leadership when additional review or direction is needed

What we offer

medical insurance
vision insurance
dental insurance
life insurance
disability insurance
401(k) plan
free online training
access to top jobs

Medical Collections Representative

We are seeking a detail-oriented Medical Collections Representative to manage a ...

Location

United States , McKinney

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2+ years of experience in medical collections, healthcare accounts receivable, or denial management
Strong knowledge of insurance claim follow-up, EOBs, remittances, appeals, and payer denial processes
Experience working with Medicare, Medicaid, and commercial insurance carriers
Familiarity with medical billing, CPT, ICD-10, and HCPCS codes preferred
Ability to handle a high-volume workload in a fast-paced revenue cycle environment
Strong communication, problem-solving, and negotiation skills
Proficiency with EMR/EHR systems, billing platforms, and payer portals
High attention to detail and strong organizational skills

Job Responsibility

Review, analyze, and work a high volume of denied medical claims from commercial, government, and managed care payers
Contact insurance companies by phone, portal, or written correspondence to resolve claim denials, underpayments, and payment delays
Investigate denial reasons and determine appropriate corrective action, including rebilling, resubmission, and appeal preparation
Prepare and submit timely, accurate appeals with all required supporting documentation
Verify claim status, eligibility, authorization, coding, and billing accuracy to identify root causes of denials
Work closely with billing, coding, payment posting, and revenue cycle teams to resolve account issues and prevent future denials
Document all account activity, follow-up efforts, and resolution details in the billing system
Maintain productivity and quality standards while managing aging accounts receivable and prioritizing high-dollar or timely filing accounts
Identify denial trends and escalate recurring payer issues to leadership as needed
Ensure compliance with HIPAA, payer regulations, and internal policies when handling patient and claim information

What we offer

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

Fulltime

Claims Resolution Representative III

The Claims Resolution Representative III is responsible for working across the p...

Location

United States of America , Albany

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate degree and 2 years of related relevant experience
or equivalent combination of education and/or experience
Excellent problem-solving skills
Excellent communication skills
Excellent customer service skills

Job Responsibility

Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable
Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections
Research claims, identify problems, and takes appropriate action to assure claim resolution
Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner
Keeps management informed of changes in billing requirements and rejection or denial codes
Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists

Fulltime

Claims Resolution Representative III

The Claims Resolution Representative III is responsible for working across the p...

Location

United States of America , Rochester

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate degree and 2 years of related relevant experience
or equivalent combination of education and/or experience
Excellent problem-solving skills
Excellent communication skills
Excellent customer service skills

Job Responsibility

Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable
Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections
Research claims, identify problems, and take appropriate action to assure claim resolution
Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner
Communicates any missing/incomplete information to providers and department administrative support staff to ensure accurate billing
Communicates with insurance representatives through telephone calls, payer website, and written communication to ensure accurate processing of claims
Collaborate with appropriate departments to generate a detailed rational for appeals and grievances to the insurance companies
Keeps management informed of changes in billing requirements and rejection or denial codes as they pertain to claim processing and coding
Escalates system issues preventing claims submission and follow-up for review and resolution
Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate

Fulltime

Claims Resolution representative iv

Wilmot Cancer Institute is looking for an experienced, compassionate, and detail...

Location

United States of America , Brockport

Salary:

20.99 - 28.34 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate's degree in Business Administration and 2 years of hospital patient accounting or consumer collections experience
or an equivalent combination of education and experience
Ability to type 25 wpm
Experience working with transplant programs including, but not limited to transplant contracting, transplant provider relations, transplant billing and collections, etc.
Must be able to multi-task and pivot across duties as needed

Job Responsibility

Acts as billing and collections resource
Completing National Marrow Donor Billing
Responsible for resolving Work Queues in EPIC
Research and analyze denials
Routinely works hospital reports to ensure claims are sent timely
Edits follow up bills originated by EPIC
Responsible for communicating with insurance companies, other payers, and patients
Trains all claims resolution specialists that join the WCI Business office

Fulltime

Claims Resolution Representative III

The Claims Resolution Representative III is responsible for working across the p...

Location

United States of America , Rochester

Salary:

19.62 - 26.49 USD / Hour

University of Rochester

Expiration Date

Until further notice

Requirements

Associate degree and 2 years of related relevant experience
or equivalent combination of education and/or experience
Excellent problem-solving skills
Excellent communication skills
Excellent customer service skills

Job Responsibility

Follows department policies and procedures and maintains and exercises comprehensive knowledge of insurance company billing requirements and regulations to research and resolve unpaid accounts receivable
Follows up on multi-faceted denials through review of remittances (EOBs), insurance correspondence, rejections
Responds to all billing-related inquiries from colleagues, departments, patients, and payors in a timely and professional manner
Keeps management informed of changes in billing requirements and rejection or denial codes
Collaborates with Claim Edit Specialists and Patient Medical Billing Specialists assigned to pre claim WQ’s to identify opportunities for improvement in clean claims rate

Fulltime

Medical AR Collections Representative

We are seeking a detail-oriented Medical AR Collections Representative to manage...

Location

United States , McKinney

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2+ years of experience in medical collections, healthcare accounts receivable, or denial management
Strong knowledge of insurance claim follow-up, EOBs, remittances, appeals, and payer denial processes
Experience working with Medicare, Medicaid, and commercial insurance carriers
Familiarity with medical billing, CPT, ICD-10, and HCPCS codes preferred
Ability to handle a high-volume workload in a fast-paced revenue cycle environment
Strong communication, problem-solving, and negotiation skills
Proficiency with EMR/EHR systems, billing platforms, and payer portals
High attention to detail and strong organizational skills

Job Responsibility

Review, analyze, and work a high volume of denied medical claims from commercial, government, and managed care payers
Contact insurance companies by phone, portal, or written correspondence to resolve claim denials, underpayments, and payment delays
Investigate denial reasons and determine appropriate corrective action, including rebilling, resubmission, and appeal preparation
Prepare and submit timely, accurate appeals with all required supporting documentation
Verify claim status, eligibility, authorization, coding, and billing accuracy to identify root causes of denials
Work closely with billing, coding, payment posting, and revenue cycle teams to resolve account issues and prevent future denials
Document all account activity, follow-up efforts, and resolution details in the billing system
Maintain productivity and quality standards while managing aging accounts receivable and prioritizing high-dollar or timely filing accounts
Identify denial trends and escalate recurring payer issues to leadership as needed
Ensure compliance with HIPAA, payer regulations, and internal policies when handling patient and claim information

What we offer

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

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Medical Claims Representative

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