Pay Growth
?
out of 5
Not enough data
Not enough info to score pay or growth
Medical Claims Representative
Job
Robert Half
Pleasanton, CA (In Person)
Full-Time
Review key factors to help you decide if the role fits your goals.
Job Security
?
out of 5
Not enough data
Calculating job security score...
Total Score
38
out of 100
Average of individual scores
Skill Insights
Compare your current skills to what this opportunity needs—we'll show you what you already have and what could strengthen your application.
Job Description
We are looking for a Medical Claims Representative to join our team in Pleasanton, California in a Contract to Permanent role. This position is ideal for someone with experience handling medical claims, billing activity, and insurance-related documentation in a fast-paced environment. The person in this role will support accurate claim review and member-related processing while communicating clearly with Spanish-speaking members and internal teams. Success in this position requires strong knowledge of medical terminology, benefit plans, and claims administration procedures.
Responsibilities:
- Review, evaluate, and process medical claims with close attention to accuracy, completeness, and applicable coverage details.
- Enter and maintain member, enrollment, beneficiary, and medical information within internal claims systems while following established procedures.
- Verify insurance details and confirm benefit eligibility to support timely and correct claim handling.
- Interpret billing information, coding details, and supporting documentation to determine appropriate claim outcomes.
- Communicate with members, providers, and internal partners regarding claim status, required documentation, and benefit-related questions.
- Assist Spanish-speaking members by providing clear and thorough support in both English and Spanish.
- Apply working knowledge of healthcare benefits, policies, and regulatory guidelines when reviewing claim activity.
- Escalate complex or legally sensitive claim matters to leadership when additional review or direction is needed.