Medical Claims Representative

Description A Medical Health Insurance Plan based in Los Angeles is in the immediate need of a Medical Claims Representative. The Medical Claims Representative will be responsible for speaking with members over the phone and troubleshooting any of the participants bills or claims. The Medical Claims Representative will be tasked with answering inquiries regarding EOBs as well as any other issues pertaining to medical claims. Once the candidate is up and running, promotions will become available. The right person for this job will have a background in either medical claims, insurance verifications/authorizations or medical billing. Research and respond to scheduled reports and claim inquiries sent by Blue Card and Blue Cross representatives in a timely manner. Investigate and adjudicate complex claim requests and claims requiring special handling, such as adjustments and complaints in accordance with Plan guidelines, policy contract language and departmental processes and standards. Write letters to participants and providers requesting additional information when necessary. Follow‐up on pending claims. Work with Eligibility Department to resolve eligibility problems, add or delete dependents, address changes, etc. Act in accordance with all HIPAA Privacy and Security guidelines to ensure confidential handlingof protected health information. Answer phone calls from participants and providers when necessary. Regular, predictable, and reliable attendance is required. Ability to accept direction and developmental guidance from supervisor. Ability to work effectively with individuals at all levels.Requirements

Extensive knowledge of medical terminology, ICD9, ICD10, and CPT codes.

Extensive knowledge of Plan benefits, group insurance, and Medicare principals.

Knowledge of Coordination of Benefits rules.

Considerable knowledge of basic math.

Ability to maintain production standards in a detail‐oriented, quality‐conscious service environment.

Ability to work independently with minimal supervision.

Strong analytical abilities.

Good written and verbal communication skills

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 to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.© 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) .