Claims Analyst 1

About the Role We are seeking a detail-oriented and self-motivated Claims Processing Specialist to join our collaborative, high-performing remote team. In this role, you will directly impact the timely delivery of healthcare and vision benefits by ensuring claims are processed accurately and efficiently. You will work independently to review, process, price, and adjudicate claims while meeting clear production and quality metrics. Key Responsibilities Queue Management: Log in daily to efficiently manage and work through assigned claim processing queues. Claims Adjudication: Review, process, price, and (when appropriate) deny medical, dental, and vision claims according to established protocols and procedures. Determine Eligibility: Process first-time claims and accurately apply policy and provider contract provisions to determine if a claim is payable. Research & Documentation: Research and determine the status of pending medical and vision-related claims, while maintaining accurate records, files, and documentation. Meet Performance Metrics: Maintain consistent weekly performance standards, with expectations of meeting at least 75% production and 96% quality targets. Continuous Learning: Successfully complete additional progressive claims training programs within 12 months of hire. Compliance: Strictly comply with all company policies, standards, and regulatory guidelines. Required Qualifications Education: High school diploma or equivalent. Experience: Minimum of 1 year of claims processing experience (healthcare, vision, or dental claims processing is strongly preferred, though general office services or physician's office experience will be considered). Computer & Systems Proficiency: Proven ability to navigate multiple applications simultaneously while maintaining high efficiency and accuracy. Proficiency in Microsoft Office (Word, Excel, etc.). Core Skills: Ability to perform basic math functions.

salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 5 PM
education: High School

Responsibilities

Queue Management: Log in daily to efficiently manage and work through assigned claim processing queues.
Claims Adjudication: Review, process, price, and (when appropriate) deny medical, dental, and vision claims according to established protocols and procedures.
Determine Eligibility: Process first-time claims and accurately apply policy and provider contract provisions to determine if a claim is payable.
Research & Documentation: Research and determine the status of pending medical and vision-related claims, while maintaining accurate records, files, and documentation.
Meet Performance Metrics: Maintain consistent weekly performance standards, with expectations of meeting at least 75% production and 96% quality targets.
Continuous Learning: Successfully complete additional progressive claims training programs within 12 months of hire.
Compliance: Strictly comply with all company policies, standards, and regulatory guidelines.

Skills

• medical claims
• reimbursement
• protocols and procedures

Qualifications

• Years of experience: 1 year
• Experience level: Experienced

Randstad is a world leader in matching great people with great companies. Our experienced agents will listen carefully to your employment needs and then work diligently to match your skills and qualifications to the right job and company. Whether you're looking for temporary, temporary-to-permanent or permanent opportunities, no one works harder for you than Randstad.

Equal Opportunity Employer: Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact [email protected].

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

It is unlawful in Massachusetts to require or administer a lie detector test as a condition of employment or continued employment. An employer who violates this law shall be subject to criminal penalties and civil liability.