Sr. Claims Specialist

Description We are looking for an experienced Sr. Claims Specialist to support insurance follow-up operations in Hinsdale, Illinois. This Long-term Contract position is ideal for someone who is detail oriented and can independently manage complex claim activity, assess supporting evidence, and make sound decisions in fast-paced environments. The role blends traditional claims investigation with the use of AI-enabled tools to strengthen fraud analysis, claim evaluation, and documentation quality.

Responsibilities:

• Oversee an active caseload of claims, maintaining consistent review and follow-up to move files efficiently through investigation and resolution.
• Examine claim records, supporting documents, statements, images, and prior file history to identify key facts, inconsistencies, and potential exposure.
• Determine appropriate claim outcomes by applying policy guidance and evidence, including approvals, denials, or referral for legal escalation when warranted.
• Use AI-supported resources such as fraud scoring, severity forecasting, image review, and document extraction tools to inform claim handling decisions.
• Assess automated insights critically, confirming accuracy and using careful judgment to adjust or override recommendations when necessary.
• Perform detailed fraud-related analysis on flagged claims to support fair, compliant, and well-documented decision-making.
• Navigate both established claims applications and newer digital platforms to complete case activity and maintain workflow continuity.
• Gather evidence manually across multiple systems and data sources when automated information is incomplete or requires verification.

The salary range for this position is $70,000 to $100,000. Benefits available to contract/temporary professionals, include 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. Our specialized recruiting professionals apply their expertise and utilize our proprietary AI to find you great job matches faster. Requirements

• Demonstrated experience handling insurance claims, claim investigations, or fraud-related file reviews in a high-volume setting.
• Strong knowledge of the full claims process, from initial review and evidence analysis through adjudication and escalation.
• Practical experience working with AI tools used in claims or fraud workflows, including scoring models, predictive analytics, or automated document and image review.
• Ability to evaluate AI-generated findings, identify limitations, and make justified adjustments based on claim facts and compliance standards.
• Hands-on familiarity with legacy claims systems as well as modern claims platforms that include embedded or integrated AI capabilities.
• Solid understanding of documentation practices, including clear recording of claim decisions, supporting rationale, and AI-related overrides.
• Knowledge of evidence standards for disputed claims, denials, and matters that may require litigation support.
• Strong analytical ability, attention to detail, and skill in synthesizing information from multiple sources into accurate claim assessments.

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. Our specialized recruiting professionals apply their expertise and utilize our proprietary AI to find you great job matches faster. 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) and Privacy Notice (https://www.roberthalf.com/us/en/privacy) .