In this vital triage role, you will serve as the initial decision-maker for claim reconsiderations and disputes, directly impacting each case's path to resolution. Operating in a collaborative and supportive remote environment, you will investigate incoming claims, verify prior authorization requirements, review medical records, and route files accurately to designated departments. Working an 8-hour shift between 8:00 AM and 6:00 PM EST (following a structured 1-on-1 virtual training program), you will manage a daily queue of approximately 50 cases while maintaining exceptional quality standards. If you bring prior authorizations or claims processing experience, strong computer literacy, and a passion for investigative problem-solving, this position offers an ideal environment to showcase your skills and grow your career.
salary: $22.99 - $23 per hour
shift: First
work hours: 8 AM - 6 PM
education: High School
Responsibilities
Position Summary:
Investigate, review, and route claim reconsiderations, verify prior authorizations, and prepare case instructions to resolve provider disputes.
Key Responsibilities:
- Investigate claim reconsideration cases and verify whether prior authorization was required and configured correctly.
- Review claim attachments and clinical documentation for medical necessity and provider-specific nuances.
- Document findings and create clear instructions for claims processors and authorization teams.
- Process a daily goal of approximately 50 cases while maintaining a 95% or higher monthly quality audit score.
- Collaborate via Microsoft Teams and utilize internal healthcare applications to route files accurately.
- High School Diploma or GED required.
- 1–2 years of experience in claims processing, prior authorizations, or utilization management.
- Proven understanding of claims resolution, reconsiderations, and disputes.
- strong computer literacy with rapid typing skills (minimum 40 WPM with 95% accuracy).
- Dedicated, private home workspace with high-speed internet capability.
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.
