Medical Claims Representative

Robert Half • Pleasanton, CA • 2h ago

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. Requirements - Prior experience in medical claims processing, claim administration, or medical billing is required.

Bilingual fluency in English and Spanish is required for effective communication with members.

Strong understanding of medical terminology and its application in billing or claims review.

Knowledge of insurance verification, benefit structures, and healthcare-related policies and procedures.

Ability to read and interpret billing codes, claim documents, and supporting records with accuracy.

Basic proficiency in Microsoft Excel and confidence learning new claims or member information systems.

Strong written and verbal communication skills with the ability to manage high-volume workloads effectively.

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.

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) .

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