"Alerted.org

Description

We are looking for a highly skilled MCO Claims Analyst to join our team on a long-term contract basis in Minneapolis, Minnesota. In this role, you will analyze and process healthcare claims while ensuring strict compliance with industry standards, organizational policies, and regulatory requirements. This position offers the opportunity to work within the dynamic healthcare industry, focusing on accuracy, efficiency, and exceptional service.

Responsibilities:

• Review and analyze medical, surgical, and behavioral health claims to ensure compliance with policies and regulations.

• Assess claim documentation to verify eligibility, coverage, and the accuracy of submitted information.

• Resolve claim disputes by investigating discrepancies and collaborating with relevant stakeholders.

• Process appeals and adjustments in alignment with established procedures and guidelines.

• Audit claims for accuracy and adherence to organizational standards.

• Coordinate with billing and benefit departments to resolve issues and ensure seamless claim administration.

• Provide detailed reporting on claim processing activities and identify areas for process improvement.

• Support team initiatives by sharing insights and contributing to a collaborative work environment.

Requirements

• Experience in a claims role at a MCO (Managed Care Organization).

• Proven experience in medical claims analysis, preferably within a managed care organization or healthcare setting.

• Strong understanding of claim administration, billing functions, and benefit processes.

• Familiarity with appeals and auditing procedures.

• Excellent analytical and problem-solving skills with a focus on accuracy and attention to detail.

• Ability to work independently and manage multiple priorities effectively.

• Strong communication skills to interact with internal teams and external stakeholders.

• Knowledge of applicable regulations and industry standards in healthcare claims.

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.

• 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) .