Medical Insurance Claims Specialist Job at Robert Half (Boise)

Medical Insurance Claims Specialist

We are looking for a Medical Insurance Claims Specialist to join a healthcare te...

Location

United States , Vancouver

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 1 year of experience in insurance verification, medical billing, claims support, or a related healthcare administrative role
High school diploma or equivalent required
additional education in healthcare administration or a related field is preferred
Working knowledge of insurance eligibility review, patient benefits coordination, and medical claims processes
Familiarity with prior authorization and referral requirements across a range of insurance carriers
Understanding of medical terminology and its application in coverage verification and billing support
Strong organizational skills with a high level of accuracy and attention to detail
Effective verbal and written communication skills, along with a customer-focused approach when assisting patients and internal teams
Proficiency with healthcare software platforms and Microsoft Office applications

Job Responsibility

Review scheduled visits and procedures to confirm active insurance coverage, plan benefits, and patient eligibility before care is delivered
Secure required prior authorizations and referrals by working directly with insurance carriers and provider offices
Enter, verify, and maintain accurate insurance and benefits information within the patient management system
Explain coverage details, expected out-of-pocket expenses, and financial obligations to patients in a clear and thorough manner
Investigate authorization issues, correct discrepancies, and follow through on missing or denied requests to support clean claim submission
Partner with billing and clinical teams to help ensure claims are supported by accurate insurance documentation and timely verification
Follow established healthcare regulations and organizational standards when handling patient information and insurance records

What we offer

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

Fulltime

Medical Insurance Claims Specialist

We are looking for a detail-oriented Medical Insurance Claims Specialist to join...

Location

United States , Spokane

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical billing, claims processing, or insurance-related roles
Familiarity with third-party payer systems and medical billing procedures
Strong knowledge of patient and insurance eligibility verification processes
Proficiency in handling insurance claims and resolving issues related to denials or discrepancies
Exceptional attention to detail and accuracy in managing financial transactions
Excellent communication skills for interacting with patients and insurance providers
Ability to work independently while adhering to established procedures and deadlines

Job Responsibility

Process medical claims for third-party payers and rebill as necessary to ensure accurate submission
Investigate unpaid claims, determine payment status, and take corrective action by appealing denials or resubmitting claims
Communicate with insurance providers to resolve discrepancies in payments or unpaid services
Identify and correct errors in claim information to ensure successful submissions
Assist patients with understanding their insurance claims and address their basic billing concerns
Provide support for patient collection inquiries during the absence of the Collections Specialist
Authorize write-offs for uncollectible balances within designated authority limits
Research and resolve credit balances, issuing refunds to the appropriate parties as necessary
Complete assigned special projects and additional tasks as required

What we offer

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

Medical Insurance Claims Specialist

We are looking for a detail-oriented Medical Insurance Claims Specialist to join...

Location

United States , Albuquerque

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

High School diploma or equivalent is required
Minimum of 2 years of experience in claims processing, healthcare operations, or related administrative functions
Strong knowledge of medical billing, insurance eligibility, and claims adjudication
Proficiency in EZCap or similar claims management platforms
Excellent attention to detail and ability to identify errors in complex data sets
Effective communication skills for resolving member concerns and collaborating with team members
Ability to analyze trends and recommend solutions for process improvements
Familiarity with compliance requirements and quality assurance standards in the healthcare industry

Job Responsibility

Conduct audits of pre-lag reports to verify accuracy, completeness, and compliance with established turnaround times
Investigate and resolve member out-of-pocket concerns to ensure proper claims adjustments
Monitor daily pre-lag reports for assigned regions and escalate compliance issues as needed
Analyze daily, weekly, and check-run reports for assigned IPAs to identify potential errors or inconsistencies
Notify management promptly about compliance concerns related to claims payment timelines
Perform quality reviews of claims processes to ensure adherence to organizational standards
Collaborate with team members to identify trends and root causes of recurring issues
Assist with benefit interpretation and claims adjustments using EZCap or similar platforms
Maintain documentation and provide detailed audit reports to support continuous improvement initiatives
Support the implementation of quality measures and compliance protocols within claims operations

What we offer

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

Medical Insurance Claims Specialist

We are looking for an experienced Medical Insurance Claims Specialist to join ou...

Location

United States , Worthington

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical claims processing and insurance eligibility verification
Strong knowledge of medical billing procedures and healthcare industry standards
Familiarity with insurance claims systems and patient data management
Excellent attention to detail and organizational skills
Ability to collaborate effectively with healthcare providers and insurance companies
Proficiency in analyzing and resolving claim-related discrepancies
Strong communication skills for interacting with patients and stakeholders
Knowledge of relevant regulations and compliance standards in medical billing

Job Responsibility

Process medical insurance claims with a high level of accuracy and attention to detail
Verify patient eligibility and insurance coverage to ensure proper billing procedures
Collaborate with healthcare providers and insurance companies to resolve claim discrepancies
Maintain comprehensive records of claims and billing activities for audit purposes
Identify and address issues with insurance claims to prevent delays in processing
Review and analyze patient data to ensure compliance with insurance requirements
Assist in the preparation and submission of claims to insurance carriers
Provide support and guidance to team members regarding claims procedures and policies
Stay updated on changes in medical billing regulations and insurance policies
Communicate effectively with patients and stakeholders to address billing inquiries

What we offer

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

Pharmacy Assistant - ODB and Private Payor Insurance Claims Specialist

Are you an experienced Pharmacy Assistant looking for a long-term career outside...

Location

Canada , Burlington

Salary:

50000.00 - 55000.00 CAD / Year ▼

Randstad

Expiration Date

July 30, 2026

Requirements

1+ years of pharmacy experience in a mid-to-high volume pharmacy setting (ideally Kroll-based - must have strong data entry / intake / insurance claim experience!)
Professional phone manner and ability to manage incoming and outgoing calls while typing at 50 WPM+
Strong working knowledge of Kroll prescription software - we are open to applicants with other software background who also possess strong MS Office skills
Proficient in Microsoft Office tools (Word, Excel, Outlook, Teams)
Excellent attention to detail, time management, and organizational skills
Comfortable working in a high-volume, structured team environment
Eager to learn and grow with a company that values your pharmacy expertise
Available to start ASAP (if you are working in a permanent role, your requirement for a 2-3 week notice period will certainly be respected, if hired)

Job Responsibility

Enter prescriptions in Kroll with accuracy and efficiency
Complete third party billing and adjudication through public and private providers, calling providers to resolve problems and understand issues
Support the prescription filling process by picking, labeling, and preparing medications
Communicate internally via email/Teams and assist with coordination of deliveries
Assist with pharmacy inventory: receiving, stocking, and tracking medications
Prepare and verify waybills and shipping details for outbound prescription deliveries
Collaborate with pharmacy technicians and pharmacists in a fast-paced, team setting
Maintain pharmacy records and assist with general housekeeping or administrative duties

What we offer

Full benefits package starting from day one
Annual Bonus Potential
3 weeks of vacation per calendar year
wellness days
paid and unpaid sick days
Retirement Program with attractive matching from the employer
Stock Purchase Program
Annual Merit Program
Career Growth opportunities

Fulltime

Medical Claims Specialist

We are looking for a dedicated Medical Claims Specialist to join our healthcare ...

Location

United States , Federal Way

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

Proven experience in medical collections, claims resolution, or revenue cycle management
Strong ability to interpret insurance contracts, documents, and regulatory guidelines
Knowledge of benefit verification and authorization processes within healthcare
Analytical skills to identify and address root causes of claim denials effectively
Reliable high-speed internet and familiarity with secure remote work systems
Proficiency in video conferencing and adherence to remote communication protocols
High level of responsiveness, urgency, and accountability in managing tasks
Ability to work exclusively for the organization without concurrent external roles

Job Responsibility

Conduct detailed benefit verification for patient insurance coverage to ensure accurate claims submission
Investigate and resolve unpaid or denied claims by analyzing root causes and utilizing available resources
Communicate effectively with insurance payers to address claim issues and facilitate timely payment
Interpret insurance contracts and regulations, ensuring compliance with state and employer-specific requirements
Participate in virtual meetings promptly, adhering to meticulous standards and security protocols
Utilize secure systems to manage sensitive data in a remote environment
Verify insurance authorizations and approvals accurately to support seamless claim processing
Collaborate with team members to resolve complex payment barriers and ensure smooth operations
Manage and resolve a set number of complex accounts daily, meeting productivity expectations
Respond promptly to supervisor and leadership inquiries during work hours, maintaining a high level of accountability

What we offer

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

Medical Insurance Collections Specialist

Join a mission-driven healthcare team where your expertise directly impacts pati...

Location

United States , Van Nuys

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

At least 3 years of experience in hospital billing and collections within a healthcare or hospital environment
Working knowledge of medical billing, medical collections, denials management, and appeals processing
Hands-on experience with hospital revenue cycle operations for both inpatient and outpatient accounts
Familiarity with Medicare managed care, Medi-Cal managed care, commercial insurance, and HMO/PPO reimbursement structures
Ability to review account details, identify payment issues, and resolve balances through organized follow-up
Strong written and verbal communication skills for payer outreach, documentation, and appeal preparation
High attention to detail and the ability to manage multiple accounts while meeting productivity expectations

Job Responsibility

Drive resolution of outstanding hospital claims by reviewing account status, contacting payers, and securing timely reimbursement
Manage collection activity across a diverse portfolio of insurance plans, including Medicare Managed Care, Medi-Cal Managed Care, commercial payers, and HMO/PPO products
Research denied and underpaid claims, identify root causes, and prepare compelling appeals with supporting documentation
Handle both inpatient and outpatient hospital billing accounts while ensuring compliance with payer requirements and contractual guidelines
Analyze payment activity, billing edits, and account trends to identify reimbursement barriers and implement corrective actions
Maintain thorough and accurate documentation of payer communication, follow-up activity, and account resolution steps
Collaborate closely with billing, coding, and revenue cycle teams to resolve claim discrepancies and improve collection performance
Adapt to department workflows and support Collector I-level processes and training initiatives as needed

What we offer

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

Fulltime

Medical Claims Resolution Specialist

We are seeking a detail-oriented Medical Claims Resolution Specialist within the...

Location

United States , Indianapolis

Salary:

Not provided

Robert Half

Expiration Date

Until further notice

Requirements

2+ years of experience in medical billing, claims resolution, accounts receivable, or revenue cycle operations
Must reside in the state of Indiana

Job Responsibility

Review and analyze denied, rejected, or outstanding medical claims to identify root causes
Research claim discrepancies, billing issues, coding errors, and payer requirements
Communicate with insurance companies, patients, and internal departments to resolve claim issues efficiently
Submit corrected claims, appeals, and supporting documentation as needed
Track claim status and maintain accurate documentation of follow-up actions and resolutions
Ensure compliance with payer guidelines, HIPAA, and company policies
Collaborate with billing, coding, and revenue cycle teams to improve claim resolution processes
Identify trends in denials and recommend process improvements

What we offer

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

Fulltime

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Medical Insurance Claims Specialist

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