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RH
Robert Half
Medical Claims Analyst
Career Insights for Claims Adjuster / Specialist (General)
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Based on Ohio data
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What they do
A Claims Adjuster or Specialist investigates and evaluates insurance claims. Specializes in a particular type of insurance. Inspects property damage, including damage to homes, buildings and cars; reviews claims after they are submitted; may authorize or deny payment for claims. May work directly for insurers or on behalf of claimants.
$73,351 / year median in Ohio
+14% projected growth
Job Description
Description We are looking for an experienced Medical Claims Analyst to support Medicaid billing operations for a long-term contract opportunity in Cleveland, Ohio. This position focuses on claims-related analysis, authorization workflows, and eligibility validation to help maintain accurate billing and reimbursement activity. The ideal candidate brings strong Medicaid expertise, confidence working with 270/271 transactions, and the ability to interpret reporting data in a fast-paced onsite environment.
Responsibilities:
- Review Medicaid-related claims activity and analyze billing information to support timely and accurate reimbursement.
- Manage pre-authorization and payer authorization processes, ensuring required approvals are secured before services are billed.
- Generate, interpret, and reconcile 270/271 eligibility and response reports to confirm coverage and support service reauthorization.
- Examine post-submission billing results to identify claim issues, track denials or rejections, and recommend corrective action.
- Validate member eligibility data for Medicaid billing and maintain accurate supporting documentation for claims processing.
- Assist with reauthorization workflows for ongoing services by using eligibility and transaction data to confirm continued coverage.
- Provide reporting support related to Medicaid billing activity and help organize information needed for limited grant invoicing tasks.
- Work closely with internal stakeholders to resolve billing discrepancies and improve the accuracy of claims-related processes. Requirements
- 5+ years of experience in medical claims, medical billing, or Medicaid-focused revenue cycle work.
- Strong hands-on knowledge of Medicaid billing regulations, claims workflows, and authorization requirements.
- Demonstrated experience working with 270/271 transactions, eligibility reporting, and service reauthorization processes.
- Ability to investigate claim denials, rejected claims, and other reimbursement issues with a high level of accuracy.
- Proficiency in Excel, including PivotTables and VLOOKUP for reporting and data analysis.
- Background in behavioral health billing or claims support is strongly preferred.
- Strong analytical, organizational, and communication skills in an onsite team environment.