Medical Claims Representative Job at Robert Half (Lincolnwood)

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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 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 working with medical claims in a healthcare, hospital, or social assistance setting
Knowledge of medical billing processes and insurance claim workflows
Familiarity with claim administration practices and claims documentation standards
Ability to perform medical insurance verification accurately and efficiently
Strong attention to detail with the ability to identify errors, missing information, and claim inconsistencies
Effective communication skills for coordinating with team members, providers, and payers
Proficiency in managing multiple tasks and maintaining accuracy in a deadline-driven environment

Job Responsibility

Review medical claims for accuracy, completeness, and proper supporting documentation before submission or follow-up
Process billing and claim-related records while maintaining compliance with healthcare and insurance guidelines
Investigate claim discrepancies and resolve issues by coordinating with internal teams, providers, and insurance contacts
Verify medical insurance details and confirm coverage information to support timely claim handling
Maintain organized claim administration records and update case information within designated systems
Monitor claim status, track outstanding items, and follow through to support prompt resolution and payment activity
Respond to inquiries related to claims and billing matters with professionalism, accuracy, and attention to detail

What we offer

medical
vision
dental
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 Customer Service Representative

We are looking for dedicated Medical Customer Service Representatives to join ou...

Location

United States , Westerville, Ohio

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of experience in medical billing, collections, or customer service
Familiarity with call center operations and patient interaction
Proficiency in basic medical terminology and patient billing processes
Ability to handle inbound calls and assist customers effectively
Strong skills in researching and resolving account discrepancies
Experience with online payment platforms and establishing payment plans
Knowledge of insurance contracts and reimbursement policies
Excellent teamwork and communication skills to collaborate with leadership and peers

Job Responsibility

Manage patient accounts efficiently to minimize receivables and reduce bad debts
Monitor payment plans to ensure compliance with established guidelines
Consult with patients to explain financial responsibilities, coverage limitations, and available payment options
Process bankruptcy paperwork and handle accounts of deceased patients
Promote patient-centered solutions to resolve account balances and ensure satisfaction
Calculate and collect payments accurately while adhering to organizational standards
Establish and manage payment plans using online platforms, ensuring compliance with approved guidelines
Research and resolve accounts receivable issues and reconcile claims discrepancies
Provide support to scheduling departments by identifying in-network insurance contracts and reimbursement policies
Assist with department coverage and perform other duties as assigned by the supervisor

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

Medical Customer Service Representative

We are looking for experienced Medical Customer Service Representatives to join ...

Location

United States , Columbus, Ohio

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Minimum of 2 years of experience in medical billing, collections, or customer service
Familiarity with basic medical terminology and patient interaction protocols
Proficiency in handling inbound call center operations related to patient inquiries
Strong skills in processing patient billing and resolving account discrepancies
Ability to establish and manage payment plans using online bill pay platforms
Experience assisting customers and addressing their account concerns
Knowledge of insurance policies, claims reconciliation, and refunds
Excellent communication and problem-solving skills with a customer-centric approach

Job Responsibility

Handle patient accounts promptly to minimize receivables and reduce bad debts
Monitor and manage payment plans in compliance with established guidelines
Consult with patients to address their financial responsibilities, insurance benefits, and payment options
Process delinquent accounts by coordinating with external collection agencies
Review and manage bankruptcy paperwork and deceased patient accounts
Promote a patient-focused approach to resolving balances and account discrepancies
Calculate and collect payments accurately, ensuring compliance with payment policies
Research accounts receivable issues and reconcile claims effectively
Provide support to scheduling teams by identifying insurance contracts and reimbursement policies
Collaborate with team members and leadership to suggest workflow improvements and enhance service experiences

What we offer

medical, vision, dental, and life and disability insurance
eligible to enroll in our company 401(k) plan

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Medical Claims Representative

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