We are looking for a dedicated Medical Claims Analyst to join our healthcare team in Minneapolis, Minnesota. In this long-term contract position, you will play a vital role in processing leave of absence claims, ensuring compliance with medical certifications, and calculating benefit allocations. This is an excellent opportunity to contribute to a fast-paced industry while leveraging your expertise in medical claims and benefits administration.<br><br>Responsibilities:<br>• Process and manage leave of absence claims by coordinating medical certifications and ensuring timely submissions.<br>• Calculate benefit amounts, including allocations from corporate and state sources, to ensure accurate disbursements.<br>• Review, approve, or deny claims based on established guidelines and medical documentation.<br>• Utilize systems such as ServiceNow and Workday to track, manage, and process claims efficiently.<br>• Maintain detailed records of claims and benefits to ensure compliance and accuracy.<br>• Communicate with healthcare providers to confirm certifications and resolve discrepancies.<br>• Address rejected claims by investigating issues and providing resolutions.<br>• Collaborate with team members to streamline leave administration processes.<br>• Provide guidance to employees regarding medical leave policies and benefits.<br>• Stay updated on state and federal regulations related to leave and benefits administration.
<ul><li><strong>Position: Claims Examiner - Lost Time (Contract Role)</strong></li><li><strong>Location: 555 Long Wharf Drive New Haven CT USA 06511-5941</strong></li><li><strong>Type: 100% Onsite</strong></li><li><strong>Hourly Pay Range: $30-33/per hour</strong></li><li><strong>Interview Process: Virtual interview 1-2 round of 30 minute interview</strong></li></ul><p> </p><p><strong>Job Description: </strong></p><p>Job Schedule-100% ONSITE</p><p>Job hours-8:30am-5:00pm EST</p><p> </p><p>3 years of Workers Compensation Lost Time Claim Examiner or Commensurate Experience </p><p> </p><p>Duties and Responsibilities:</p><p>- Handles all aspects of workers compensation lost time claims from set-up to case closure ensuring strong customer relations are maintained throughout the process.</p><p>- Reviews claim and policy information to provide background for investigation.</p><p>- Conducts 3-part ongoing investigations obtaining facts and taking statements as necessary with insured claimant and medical providers.</p><p>- Evaluates the facts gathered through the investigation to determine compensability of the claim.</p><p>- Informs insureds claimants and attorneys of claim denials when applicable.</p><p>- Prepares reports on investigation settlements denials of claims and evaluations of involved parties etc.</p><p>- Timely administration of statutory medical and indemnity benefits throughout the life of the claim.</p><p>- Sets reserves within authority limits for medical indemnity and expenses and recommends reserve changes to Team</p><p>Leader throughout the life of the claim.</p><p>- Reviews the claim status at regular intervals and makes recommendations to Team Leader to discuss problems and remedial actions to resolve them.</p><p>- Prepares and submits to Team Leader unusual or possible undesirable exposures when encountered.</p><p>- Works with attorneys to manage hearings and litigation</p><p>- Controls and directs vendors nurse case managers telephonic cases managers and rehabilitation managers on medical management and return to work initiatives.</p><p>- Complies with customer service requests including Special Claims Handling procedures file status notes and claim reviews.</p><p>- Files workers compensation forms and electronic data with states to ensure compliance with statutory regulations.</p><p>- Refers appropriate claims to subrogation and secures necessary information to ensure that recovery opportunities are maximized.</p><p>- Works with in-house Technical Assistants Special Investigators Nurse</p><p>Consultants Telephonic Case Managers as well as Team Supervisors to exceed customer's expectations for exceptional claims handling service.</p>
We are looking for a skilled Claims Examiner specializing in lost time claims to join our team on a contract basis in Jersey City, New Jersey. In this role, you will oversee the full lifecycle of workers' compensation claims, ensuring compliance with regulations while maintaining strong relationships with all involved parties. This position requires someone with excellent attention to detail, capable of managing complex claims processes and delivering high-quality service.<br><br>Responsibilities:<br>• Manage workers' compensation lost time claims from initial setup to closure, maintaining excellent customer relationships throughout the process.<br>• Conduct thorough investigations by reviewing policy details, collecting statements, and gathering facts from claimants, insured parties, and medical providers.<br>• Evaluate gathered information to determine claim compensability and communicate decisions regarding claim approvals or denials to all relevant parties.<br>• Administer statutory medical and indemnity benefits in a timely manner, ensuring compliance with applicable regulations.<br>• Set and adjust claim reserves for medical, indemnity, and related expenses, recommending changes to the Team Leader as necessary.<br>• Partner with attorneys to oversee litigation processes, including hearings, and manage legal documentation.<br>• Direct and coordinate efforts with vendors, nurse case managers, and rehabilitation managers to support medical management and return-to-work initiatives.<br>• Prepare and submit reports on claim settlements, denials, evaluations, and potential exposures to the Team Leader.<br>• Ensure compliance with state regulations by filing workers' compensation forms and electronic data accurately and on time.<br>• Identify subrogation opportunities and work to recover claim-related costs effectively.
<p>We are looking for several detail-oriented Revenue Cycle Clerks to join our team in Federal Way, Washington. This long-term contract position focuses on managing and analyzing credit balances within the healthcare revenue cycle. The role involves critical thinking, problem-solving, and a strong ability to investigate and resolve discrepancies in medical claims. After completing a two-week in-office training, the position transitions to a fully remote setup.</p><p><br></p><p>Responsibilities:</p><p>• Analyze credit balances and determine appropriate actions to address overpayments from insurance payers.</p><p>• Conduct thorough investigations into medical claims to identify discrepancies and root causes.</p><p>• Process refunds and adjustments accurately, ensuring compliance with healthcare billing standards.</p><p>• Utilize payer portals and electronic remittance systems to review and resolve claims issues.</p><p>• Collaborate with internal teams to ensure proper documentation and resolution of revenue cycle tasks.</p><p>• Apply critical thinking to identify patterns and suggest process improvements.</p><p>• Participate in a structured training program combining classroom learning and hands-on practice.</p><p>• Handle retractions and adjust financial records based on investigative findings.</p><p>• Manage data using internal tools, Outlook, Excel, and SharePoint.</p><p>• Communicate effectively with stakeholders to address queries and provide updates.</p>
Data Analyst Manager (2)<br><br>Roles & Responsibilities <br><br>Oversee an offshore team of Healthcare Data Analysts and QA engineers under the direction of the Director of Data Management.<br>Collaborate with various client-facing teams and both inter-departmental and intra-departmental teams to address complex healthcare challenges.<br>Take the lead in communicating with clients to resolve any technical issues they may have.<br>Guide the Data Operations team in understanding customer business needs and converting them into application and operational requirements..<br>Act as a process champion, utilizing in-depth knowledge of organization policies and operations processes.<br>Ensure modules in the product meet the functional requirements, system compliance, and interface specifications through ongoing performance monitoring of team members.<br><br><br>Bachelor’s Degree or equivalent industry experience<br>7+ years of experience performing analysis on healthcare data<br>Clinical Knowledge of various Healthcare Data listed above<br>Advanced skillset with SQL for data analysis and reporting <br>Strong verbal and written communication skills<br>Currently eligible to work in the U.S. without assistance in getting an employment visa or work authorization.<br>Required Knowledge Areas<br>Data Analytics & Statistics Experience<br>SQL & Databases – Experience writing queries to extract and manipulate data from SQL Server, PostgreSQL, MySQL, or Oracle databases.<br>Excel & Spreadsheets – Advanced Excel skills (pivot tables, VLOOKUP, tables and charts )<br>Healthcare Industry Knowledge<br>Healthcare Data Standards – Understanding of ICD-10, CPT, HCPCS, LOINC, and SNOMED coding systems.<br>Electronic Health Records (EHRs) – Experience with Epic, Cerner, Meditech, or other EHR platforms.<br>HIPAA & Data Privacy – Familiarity with healthcare data compliance, including HIPAA, GDPR, and HITECH Act.<br>Claims & Billing Data – Experience analyzing claims from Medicare, Medicaid, and private insurers.<br>HEDIS Quality Measures <br>CMS Data <br>Data Management & ETL Experience<br>ETL (Extract, Transform, Load) Processes – Experience working with data warehouses, SQL ETL pipelines<br>Big Data & Cloud Platforms – Familiarity with AWS (Redshift), Google Cloud, and/or Azure a plus.<br>Project Management – Familiarity with Agile, Scrum, or Lean methodologies in data projects.<br>Stakeholder Communication – Ability to translate complex data findings into actionable insights for non-technical teams (clinicians, executives, analysts).<br> <br><br>Preferences – Not Required <br><br>10+ years of experience performing analysis on healthcare data<br>Experience with Snowflake <br>Prior Experience Working with Offshore Teams a Plus<br>Team leadership experience
<p>A Senior Software Business Analyst is needed to play a crucial role in connecting business requirements to technical solutions. This role involves engaging with stakeholders to gather and analyze requirements, transforming them into actionable functional specifications. Responsibilities include evaluating existing processes, offering solutions to drive business value, and ensuring project success under tight timelines. The position also includes mentoring junior analysts, leading cross-departmental projects, and fostering innovation. Strong analytical and communication skills, along with a solid understanding of software development life cycles, are essential to succeed in this fast-paced environment.</p><p>The ideal candidate will work closely with development and QA teams to monitor project milestones, provide updates to stakeholders, and address any project risks and challenges. A proactive approach to improving application usability and efficiency will be critical. Focusing on the specialty pharmacy sector, the organization provides end-to-end solutions including hub services, pharmacy network management, group purchasing (GPO) services, cutting-edge technology platforms, and more. With a strong presence as an industry advocate, the focus remains on delivering strategic channel management, advanced products, and tailored services to optimize patient outcomes and improve healthcare delivery.</p><p><br></p><p><strong>** Qualified candidates should have experience with pharmacy insurance, medical insurance, and claims processing **</strong></p><p><br></p><p><strong>Key Responsibilities:</strong></p><ul><li>Collect and translate business requirements into detailed functional specifications for new and existing systems.</li><li>Perform gap analyses between current system capabilities and business needs using tools like Confluence, flowcharts, and wireframes to document workflows.</li><li>Create use cases for review during functional testing phases by developers and QA teams.</li><li>Work with IT teams to evaluate project scope and affected systems, providing strategic insights.</li><li>Assess new methodologies for feasibility and implementation efficiency.</li><li>Gain in-depth knowledge of internal software platforms and their underlying functionalities.</li><li>Analyze and optimize existing processes to identify inefficiencies and propose re-engineering solutions.</li><li>Host regular meetings with development teams to resolve obstacles and track progress.</li><li>Provide project status reports to business stakeholders.</li><li>Identify potential risks and escalate issues as required.</li><li>Continuously explore opportunities to improve application functionality, making recommendations for enhancements.</li><li>Maintain compliance with HIPAA regulations and related amendments</li></ul>
<p>We are looking for a dedicated Case Manager to join a stable team in Sherman Oaks looking to add a new member of the team. This firm specializes in personal injury cases, and this role is crucial to ensuring clients receive the support and advocacy they need throughout the claims process. The ideal candidate will thrive in a collaborative and focused environment while demonstrating exceptional organizational and communication skills.</p><p><br></p><p>Responsibilities:</p><p>• Manage claims processing with various insurance carriers, including health insurance providers, Medicare, and MediCal.</p><p>• Resolve property damage and loss of use claims efficiently and effectively.</p><p>• Coordinate with healthcare providers to schedule medical appointments for injury treatment.</p><p>• Advocate for clients by monitoring medical treatments and organizing care based on provider recommendations.</p><p>• Review, analyze, and interpret medical records, surgical reports, and medical bills.</p><p>• Prepare comprehensive case files for submission to the demands department.</p><p>• Maintain clear and precise communication with clients, healthcare providers, and internal staff.</p><p>• Collaborate with team members to ensure seamless case management and support.</p><p>• Utilize case management software and tools to maintain accurate and organized documentation.</p>
<p>Are you a motivated, strategic thinker with a knack for turning data into actionable insights? As a Data Analyst at our East Bay client, you’ll be at the heart of helping our client's team build stronger connections between the dashboards they produce and the internal teams who use them. This newly created role will support the client's dynamic data team as they tackle the challenge of making analytics more impactful and user-friendly.</p><p><br></p><p>This role is hybrid 50% onsite, and is a long-term contract role that could possibly convert to FTE.</p><p> </p><p>Key Responsibilities:</p><p>In this role, you will:</p><p>-Partner with the data team to ensure insights are seamlessly integrated into business workflows.</p><p>-Collaborate with end users to boost the adoption and effective utilization of Power BI dashboards.</p><p>-Gather and analyze business requirements to ensure solutions align with real-world use cases and enhance decision-making.</p><p>-Offer training and hands-on support for users learning to navigate dashboards and self-service analytics tools.</p><p>-Troubleshoot data issues, validate ad-hoc data requests, and recommend process improvements to increase data quality and accuracy.</p><p>-Work with business leaders to support team deliverables and improve operational outcomes.</p>
<p>We are looking for a dedicated Claims Admin Support Specialist to join our client's team in Oxford, MS. In this role, you will handle a variety of clerical tasks, ensuring smooth office operations and providing support to internal teams. This is a long-term contract position, offering an excellent opportunity to utilize your organizational skills and attention to detail.</p><p><br></p><p>Responsibilities:</p><p>• Manage and maintain office supplies to ensure adequate inventory levels.</p><p>• Operate and oversee office equipment, including fax machines, printers, and copiers, ensuring functionality and addressing issues as needed.</p><p>• Coordinate document shredding services with external vendors to maintain compliance with company policies.</p><p>• Organize, retrieve, and deliver files while performing document scanning and copying as required.</p><p>• Draft and send routine correspondence, ensuring professionalism and accuracy.</p><p>• Welcome visitors and address routine inquiries or direct them to the appropriate department.</p><p>• Sort, open, and distribute incoming mail and packages, including FedEx and other courier services.</p><p>• Assist with scheduling meetings, maintaining records, and organizing retention processes.</p><p>• Perform additional research, reporting, and administrative tasks as requested by leadership.</p><p>• Travel occasionally to fulfill job-related responsibilities.</p>
We are looking for a Claims Admin Support Specialist to join our team in Maitland, Florida. This role involves performing a variety of administrative and clerical tasks, ensuring office operations run smoothly under direct supervision. As this is a long-term contract position, it offers stability and an opportunity to contribute to a dynamic work environment.<br><br>Responsibilities:<br>• Maintain and manage the inventory of office supplies to ensure availability for daily operations.<br>• Operate and oversee office equipment such as fax machines, printers, and copiers, ensuring proper functionality.<br>• Coordinate document shredding services with external vendors to uphold confidentiality standards.<br>• Handle document management tasks, including retrieving files, making copies, and delivering documents as needed.<br>• Draft routine correspondence and respond to visitor inquiries with professionalism and efficiency.<br>• Open, sort, and distribute incoming mail and packages, including deliveries from FedEx and other couriers.<br>• Assist in organizing meetings, coordinating record retention, and performing additional clerical support as requested.<br>• Conduct research and compile reports based on leadership requests to support decision-making processes.<br>• Occasionally travel to fulfill job-related duties and meet organizational needs.
<p>Reputable personal injury firm is seeking an experienced and compassionate Case Manager to join their team. This position is ideal for someone with a strong background in personal injury law who thrives in a fast-paced environment and is committed to delivering exceptional client service. As a key member of our legal team, you will play a vital role in managing cases, communicating with clients, and supporting attorneys to ensure successful outcomes.</p><p><br></p><p>Responsibilities:</p><p>• Conduct initial interviews with prospective clients to gather relevant case information.</p><p>• Request, review, and organize medical records related to client cases.</p><p>• Maintain consistent communication with insurance companies, medical providers, and clients to provide updates and address inquiries.</p><p>• Draft and send correspondence letters to clients, insurance companies, and healthcare providers.</p><p>• Collaborate closely with attorneys to review case status and develop strategies.</p><p>• Perform investigative tasks related to claims and pre-litigation case work.</p><p>• Manage administrative duties such as faxing, filing, and copying to support case management.</p><p>• Oversee and prioritize a substantial caseload while ensuring accuracy and timeliness.</p><p>• Assist staff and team members with various tasks, ensuring seamless workflow and collaboration.</p><p>• Utilize software tools, including Microsoft Word and Excel, to maintain organized records and documentation.</p>
We are looking for an experienced Insurance Service Associate to join our team on a long-term contract basis in Rochester, New York. In this role, you will provide exceptional customer service to clients in the Paychex Property and Casualty Insurance division, ensuring that all claims and inquiries are managed efficiently and in alignment with company policies. This position offers an opportunity to work in a fast-paced environment, where attention to detail and effective communication are essential.<br><br>Responsibilities:<br>• Deliver outstanding customer service to clients by addressing inquiries, resolving complaints, and processing claims in adherence to company policies.<br>• Develop and maintain a solid understanding of the Paychex Property and Casualty Insurance product offerings.<br>• Utilize various software systems, including Salesforce and Adobe Flex, to manage client interactions and maintain accurate records.<br>• Perform data entry tasks with precision, ensuring timely and organized completion of assignments.<br>• Document all client interactions and service activities to maintain detailed and accessible records.<br>• Collaborate with team members and other departments to ensure seamless customer service delivery.<br>• Prioritize and organize tasks effectively to meet deadlines and support operational efficiency.<br>• Stay updated on industry procedures and policies to enhance service quality and compliance.<br>• Assist with administrative tasks such as photocopying, scanning, and preparing documents.<br>• Provide support for HRIS systems and other tools integral to operations.
We are looking for a dedicated Insurance Service Associate for Property and Casualty to join our team in Rochester, New York. In this long-term contract position, you will provide exceptional customer service to clients, ensuring their needs are addressed promptly and with attention to detail. Your role will involve handling client interactions, resolving complaints, and maintaining accurate documentation in alignment with company policies.<br><br>Responsibilities:<br>• Deliver outstanding customer service to clients by addressing inquiries and resolving claims in a timely and detail-oriented manner.<br>• Maintain accurate records of all client interactions, ensuring compliance with company policies and procedures.<br>• Utilize software tools, including Salesforce and Adobe Flex, to manage customer data and streamline processes.<br>• Develop a foundational understanding of Paychex products to better support client needs.<br>• Perform data entry tasks with a focus on prioritization and organizational accuracy.<br>• Handle complaints effectively, ensuring fair resolutions while maintaining positive customer relations.<br>• Collaborate with team members to provide quality service and support for property and casualty insurance clients.<br>• Scan, photocopy, and organize documents as needed to support administrative functions.<br>• Stay updated on industry best practices and internal procedures to enhance service delivery.<br>• Assist in claim administration and policy-related tasks to ensure seamless operations.
<p>We are looking for a dedicated Case Manager to join our team in San Francisco, California. In this contract role, you will provide critical support to formerly homeless individuals, helping them access resources, maintain housing stability, and improve their overall quality of life. This position requires a proactive approach to case management and collaboration with tenants, hotel staff, and external service providers.</p><p><br></p><p>Responsibilities:</p><p>• Manage a caseload of 60-90 tenants, including individuals with mental health, substance abuse, and medical challenges, ensuring their housing stability.</p><p>• Conduct outreach visits upon tenant entry to housing, as well as follow-up assessments to address ongoing needs.</p><p>• Provide comprehensive case management services focused on tenant-driven goals such as housing retention and life improvement.</p><p>• Assist tenants in securing benefits, making rent payments, and addressing unit habitability concerns.</p><p>• Facilitate tenant referrals to employment programs, social services, and other community resources based on individual needs.</p><p>• Organize community-building activities, including tenant groups, events, and social initiatives to foster a supportive living environment.</p><p>• Respond to tenant crises through de-escalation techniques and appropriate interventions.</p><p>• Partner with property management staff and external providers to ensure tenants receive necessary support.</p><p>• Maintain accurate and organized case files, ensuring confidentiality and compliance with documentation standards.</p><p>• Report suspected abuse or neglect to appropriate authorities and adhere to legal reporting requirements.</p><p><br></p><p>** If you're interested in this position, please apply to this position and contact Kaylen Dalmacio at Kaylen.dalmacio - at - roberthalf - .com with your word resume and reference job ID#*00410-0013293596*</p>
<p>The Prior Authorization Specialist is responsible for obtaining and processing all prior authorization requests, coordinating phone calls, entering, and tracking data from insurance providers and health plans regarding authorization, expedited reviews, and appeals. The Prior Authorization Specialist is required to document and track all communication attempts with insurance providers and health plans, follow up on all denials while working to ensure services are validated Duties and Responsibilities.</p><p><br></p><p>o Reviews accounts, and initiate pre-authorizations, and other requirements related to managed care; route to appropriate departments as needed.</p><p>o Collects demographic, insurance, and clinical information to ensure that all reimbursement requirements are met.</p><p>o Assists in monitoring utilization services to assure cost effective use of medical resources through processing prior authorizations.</p><p>o Assists with medical necessity documentation to expedite approvals and ensure that appropriate follow-up is performed.</p><p>o Provides consistent and comprehensive information (both in writing and verbally) to facilitate approvals.</p><p>o Ensures insurance carrier documentation requirements are met and authorization documentation is entered and recorded in the patient's records. </p><p>o Appeals pre-authorization denials and/or set-up peer to peer reviews. </p><p>o Maintains extensive knowledge and expertise of insurance companies and billing authorization requirements.</p><p>o Submitting Authorization as required and ensuring all applicable codes, and information required were submitted to the appropriate payer.</p>
<p>We are looking for a detail-oriented Personal Injury Plaintiff Case Manager to join our team in Los Angeles, California. In this role, you will oversee personal injury cases, ensuring efficient claim processing, effective communication, and timely management of client needs. The ideal candidate will have a strong background in case management and a commitment to delivering exceptional client service.</p><p><br></p><p>Responsibilities:</p><p>• Process and open health insurance claims with accuracy and attention to detail.</p><p>• Upload and organize critical documents into the company’s case management software.</p><p>• Schedule and coordinate medical appointments while maintaining an up-to-date calendar.</p><p>• Serve as the primary point of contact for clients, addressing their concerns promptly and professionally.</p><p>• Ensure proper documentation and tracking of case details to support smooth claim administration.</p><p>• Collaborate with internal teams to streamline workflows and maintain case progress.</p><p>• Utilize CRM tools to manage client interactions and maintain detailed records.</p><p>• Monitor case timelines and ensure all deadlines are met.</p><p>• Stay informed about personal injury law and regulations to provide informed support.</p><p>• Maintain confidentiality and adhere to legal compliance standards.</p>
<p>We are looking for a dedicated Case Manager Admin to join our team in San Francisco, California, on a contract basis. In this role, you will provide comprehensive case management services to a diverse population of formerly homeless adults, many of whom face challenges related to mental health, substance use, or medical issues. This position requires strong organizational skills, compassion, and the ability to collaborate with tenants and various stakeholders to promote housing stability and community engagement.</p><p><br></p><p>Responsibilities:</p><p>• Conduct initial and ongoing needs assessments, outreach visits, and follow-ups to ensure tenants receive appropriate services.</p><p>• Build rapport with tenants and intervene effectively to address housing and life challenges.</p><p>• Assist tenants with securing and maintaining benefits and meeting rent payment obligations.</p><p>• Address unit habitability concerns and collaborate with hotel staff during inspections and pest control visits.</p><p>• Organize community-building events, tenant groups, and social activities to foster a supportive environment.</p><p>• Refer tenants to suitable job placement programs and other resources based on individual needs.</p><p>• Respond to tenant crises, offering de-escalation support and working with relevant departments and providers.</p><p>• Maintain accurate and organized tenant case files, ensuring confidentiality and compliance with regulations.</p><p>• Participate in agency-wide initiatives, such as energy program and income recertification efforts.</p><p><br></p><p>** If you're interested in this position, please apply to this position and contact Allison Jacques at Allison.jacques - at - roberthalf - .com with your word resume and reference job ID#*00410-0013301322*</p>
