Medical Claims Representative

Description We are looking for a competent Medical Claims Representative to join our team in Los Angeles, California. The Medical Claims Representative will be primarily responsible for monitoring, investigating and analyzing relevant agreements, as well as handling claims payments and maintaining effective communication with various stakeholders.Responsibilities: Handle the filing and pursuit of claims payments meticulously and efficiently. Answering inquiries regarding EOBs as well as any other issues pertaining to medical claims Monitor and analyze healthcare industry trends and developments, and understand their implications on claims. Investigate potential violations of collective bargaining agreements and take necessary action. Maintain timely and effective communication with members, agents, attorneys, and company representatives. Manage workload independently, ensuring all tasks are completed accurately and on time. Work closely with the legal department to provide information/analysis of associated claims. Research and analyze various agreements, including member contracts, assumption agreements and distribution agreements. Handle appeals, benefit functions, billing functions, claim administration, and collection processes effectively. Maintain a strong focus on customer service, ensuring all queries and issues are resolved promptly and professionally.Requirements Medical Claims Familiarity with Medical Insurance or Medical Billing Experience in managing Appeals processes Understanding of Benefit Functions within a healthcare setting Proficiency in Billing Functions specific to medical claims Experience in Claim Administration procedures and processes Familiarity with Collection Processes in a healthcare environmentRobert 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.Robert Half will consider for employment qualified applicants with arrest or conviction records in accordance with the Los Angeles County Fair Chance Ordinance for Employers and the California Fair Chance Act. 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.© 2025 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) .