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Medical Insurance Claims Specialist

https://www.roberthalf.com Logo

Robert Half

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Location:
United States , Albuquerque

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Category:

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Contract Type:
Not provided

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Salary:

Not provided

Job Description:

We are looking for a detail-oriented Medical Insurance Claims Specialist to join our team on a long-term contract basis. In this role, you will play a critical part in ensuring the accuracy, compliance, and quality of claims processing within the healthcare industry. Working remotely but closely with the team based in San Diego, California, you will help support better financial and member outcomes while contributing to a collaborative and fast-paced environment.

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

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
What we offer:
  • medical, vision, dental, and life and disability insurance
  • eligible to enroll in our company 401(k) plan

Additional Information:

Job Posted:
March 27, 2026

Work Type:
Remote work
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