This fast-paced role is ideal for a collaborative problem-solver who enjoys navigating multiple software systems and working independently under limited supervision. If you have a solid foundation in claims processing, pharmacy logistics, or medical terminology and are looking for a stable, long-term opportunity to grow your career within an industry-leading healthcare network, we want to see your application!
salary: $20.14 - $20.15 per hour
shift: First
work hours: 8 AM - 5 PM
education: Bachelors
Responsibilities
Position Summary: Research, investigate, and process member and provider appeals, medical grievances, corrected claims, and historical medical records. This production-driven role ensures total alignment with internal corporate guidelines, State and Federal statutes, and strict industry accreditation timelines.
Key Responsibilities:
- Analyze and research medical grievances and appeals for final resolution, or prepare files for clinical staff and Medical Director review.
- Conduct thorough investigative research using vendor medical management, pharmacy systems, and multiple claims portals.
- Review physical medical records carefully to confirm they satisfy requested coverage documentation guidelines.
- Initiate necessary data corrections and financial claims adjustments originating from appeal decisions.
- Monitor departmental proxy boxes and incoming call queues diligently to maintain strict regulatory compliance timelines.
Skills
Qualifications
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 HRsupport@randstadusa.com.
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.
