Medical Claims Analyst

Description We are offering a long term contract employment opportunity for a Medical Claims Analyst to join our team in the insurance industry, located in Plantation, Florida. This role involves overseeing a revised claims process and managing a team of claims processors. The focus is to ensure that claims are filed in a timely manner, with an emphasis on maintaining seamless daily operations.Responsibilities: Oversee the end-to-end claims submission, evaluation, and resolution process in accordance with company policies. Review claims for validity, completeness, and compliance with policy terms, which may involve verifying medical necessity and assessing whether provided services are covered under the member's plan. Communicate with members, healthcare providers, and other stakeholders to gather necessary information, provide updates on the status of claims, and resolve any arising issues. Lead and mentor a team of claims specialists, providing guidance, training, and support to ensure productivity and quality of work. Monitor claims data, generate reports, and analyze trends to identify areas for improvement in the claims process, which may involve collaboration with other departments to enhance overall service delivery. Ensure compliance of the claims process with all relevant regulations, policies, and procedures, including state and federal laws governing healthcare and insurance. Address any disputes or escalations related to claims, working towards resolving issues in a way that is fair to both the company and the member. Requirements Proficiency in using Allscripts and Cerner Technologies Proficiency in Cl Programming and CMS Platform Proficiency in Computer Programs related to insurance and medical claims Experience in handling appeals related to medical claims Auditing skills, especially in the context of medical claims Understanding of Benefit Functions within the insurance industry Familiarity with Billing Functions, particularly those related to medical claims Experience in Claim Administration, ideally in a medical or insurance setting Robert Half is the world’s first and largest specialized talent solutions firm that connects highly qualified job seekers to opportunities at great companies. We offer contract, temporary and permanent placement solutions for finance and accounting, technology, marketing and creative, legal, and administrative and customer support roles.Robert Half works to put you in the best position to succeed. We provide access to top jobs, competitive compensation and benefits, and free online training. Stay on top of every opportunity - whenever you choose - even on the go. Download the Robert Half app (https://www.roberthalf.com/us/en/mobile-app) and get 1-tap apply, notifications of AI-matched jobs, and much more.All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available including medical, vision, dental, life and disability insurance. Employees hired for our FTEP Program are also eligible to enroll in our company’s 401(k) or deferred compensation plan (if eligible). FTEP employees also earn paid time off for vacation, personal needs, and sick time and paid holidays. The amount of Choice Time Off (CTO) received varies based on years of service and is pro-rated based on the hours worked per week. A new FTEP employee earns up to 13 days of CTO and up to 10 paid holidays per calendar year. Learn more at roberthalfbenefits.com/Resources.© 2024 Robert Half. An Equal Opportunity Employer. M/F/Disability/Veterans. By clicking “Apply Now,” you’re agreeing to Robert Half’s Terms of Use (https://www.roberthalf.com/us/en/terms) .