Medical Claims Processor

Russell Tobin & Associates is currently seeking a Medical Claims Specialist, 5 Months Contract role for one of our Fortune 500 clients, for Lehi, UT 84043 (Hybrid). Apply today for immediate consideration.

Position: Medical Claims Specialist

Location: Lehi, UT 84043 (Hybrid)

Duration: 5 months with possible extensions

Pay rate: $20.00-23.00/hr on w2

Job Summary:

• Serve as a primary liaison between healthcare providers delivering timely, accurate, and professional support via phone and provider portal messaging
• Build and maintain strong relationships with provider offices, fostering trust and long-term partnership
• Investigate and resolve complex provider inquiries related to:
• Claims submission, status, and adjudication
• Benefit and plan interpretation
• Member cost-sharing and billing questions
• Prior authorizations and coordination of benefits
• Appeals and overpayment recoupment
• Verify and communicate patient eligibility, coverage details, and accumulator balances
• Document all interactions thoroughly and accurately within internal systems
• Collaborate cross-functionally (Claims, Product, Network, etc.) to drive timely and effective issue resolution
• Identify trends in provider issues and escalate systemic problems for root cause analysis and resolution
• Contribute to the development and refinement of internal tools, workflows, and training materials
• Educate providers on self-service tools and best practices to improve efficiency and reduce friction
• Meet or exceed established Service Level Agreements (SLAs) for response and resolution times
• Providers receive clear, accurate, and timely resolutions with minimal follow-up
• High-quality documentation and strong attention to detail across all interactions
• Demonstrated ability to independently resolve complex and ambiguous issues
• Consistent identification of trends and proactive contributions to process improvements
• Positive feedback from providers and internal stakeholders

Basic Qualifications

• 2 years of experience in healthcare operations, provider support, or medical claims
• Strong understanding of claims adjudication, eligibility, and prior authorization processes
• Excellent written and verbal communication skills, with the ability to explain complex information clearly
• Highly organized with strong attention to detail and documentation accuracy
• Ability to manage multiple priorities in a fast-paced, high-volume environment
• Experience working independently in a remote or hybrid setting
• Familiarity with HIPAA and patient confidentiality requirements
• Proven problem-solving skills and ability to navigate ambiguity

Preferred Qualifications

• Experience in provider-facing or B2B support roles within healthcare
• Familiarity with tools such as Availity, Zelis, or similar clearinghouse platforms
• Experience with contact center systems and case management tools (e.g., Assist)
• Understanding of common claim denial reasons and healthcare payment cycles
• Bachelor’s degree in healthcare administration or a related field (or equivalent experience)
• Provider portals and clearinghouses (e.g., Availity, Zelis)
• CRM or case management systems (e.g., Assist)
• Internal knowledge bases and documentation tools

Russell Tobin offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), a 401(k)-retirement savings, life & disability insurance, an employee assistance program, identity theft protection, legal support, auto and home insurance, pet insurance, and employee discounts with some preferred vendors.