You are applying for a position through Medix, a staffing agency. The actual posting represents a position at one of our clients.

Job Summary

Our client is seeking a Claims Review Specialist to join their growing self-funded insurance team. This role is critical in supporting the claims lifecycle by acting as a key problem-solver and “buffer” between internal teams, brokers, and carriers. Due to rapid organizational growth, the team is scaling quickly and looking for individuals who can contribute immediately in a fast-paced, high-volume environment.

Key Responsibilities

• Investigate and resolve complex medical claims issues, including denied, delayed, or incorrectly processed claims.
• Coordinate documentation and communication across internal teams, brokers, carriers, and external partners.
• Troubleshoot claims discrepancies, identify root causes, and support end-to-end claim resolution.
• Manage claim reporting and internal tracking logs to ensure accuracy throughout the lifecycle.
• Review reimbursement requests for completeness, submit claims, and follow up on outstanding payments.
• Support year-end reconciliation and account closure activities.
• Ensure accurate and timely correspondence with all stakeholders, including emails, reports, and documentation.
• Communicate findings, updates, and resolutions clearly across all parties involved in the claims process.
• Collaborate cross-functionally to ensure claims are processed accurately and efficiently from start to finish.

Qualifications

• Strong Excel proficiency, including sorting, filtering, and navigating data; basic data handling required.
• Experience working in a corporate or structured office environment.
• Ability to learn and operate within claims systems and structured workflows.
• Healthcare claims experience, particularly on the payer-side, benefits, or claims processing background preferred, but not required.
• Experience in high-volume or fast-paced operational environments.
• Exposure to cross-functional work with internal teams, carriers, or external partners.
• Medical office or healthcare administrative experience, including roles such as front office, medical scribe, or technician with analytical components.

Additional Requirements

• 5 days onsite during the first 90 days of training. After training, hybrid schedule: Tuesday-Thursday onsite, Monday & Friday remote.
• Flexible start times between 7:00 AM – 9:00 AM.
• Standard 8-hour workday with a 30-minute or 1-hour unpaid lunch.

Benefits

• Paid Sick Leave (Medix provides paid sick leave according to state and local sick leave ordinances).
• Health Benefits / Dental / Vision (Medix offers 6 different health plans: 3 Major Medical Plans, 2 Fixed Indemnity Plans (Standard and Preferred), and 1 Minimum Essential Coverage (MEC) Plan. Eligibility for health benefits is based on verifying that an average of 30 hours per week during the first 4 weeks of the work assignment has been met. If you meet eligibility requirements and take action to enroll, you will be covered no earlier than 60 days into your assignment, depending on plan selection(s)).
• 401k (Eligible on the first 401k open enrollment date following 6 consecutive months on assignment. 401k Open Enrollment dates are 1/1, 4/1, 7/1, and 10/1).
• Short Term Disability Insurance.
• Term Life Insurance Plan.

Required Employment / Compliance Language

Medix is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, or protected veteran status and will not be discriminated against on the basis of disability.

^*We will consider for employment all qualified Applicants, including those with criminal histories, in a manner consistent with the requirements of applicable federal, state, and local laws, including the City of Los Angeles' Fair Chance Initiative for Hiring Ordinance (FCIHO), Los Angeles Fair Chance Ordinance for Employers (ULAC), The San Francisco Fair Chance Ordinance (FCO), and the California Fair Chance Act (CFCA).

Medix Overview:

With over 20 years of experience connecting organizations with highly qualified professionals, Medix is a leading provider of workforce solutions for clients and candidates across the healthcare, scientific, technology, and government industries. Through our core purpose of positively impacting lives, we’re dedicated to creating opportunities for job seekers at some of the nation's top companies. As an award-winning career partner, Medix is committed to helping talent find fulfilling and meaningful work because our mission is to help you achieve yours.

^*As a job position within our Insurance division, a successful completion of a background check may be required as a condition of employment. This requirement is directly related to essential job functions including but not limited to: accessing medical and confidential records, verifying financial information, and working within departments that care for vulnerable populations, such as, minors, elderly and those with physical or mental disabilities. Due to these job duties, this position has a significant impact on the business operations and reputation, as well as the safety and well-being of individuals who may be cared for as part of the job position or who may interact with staff or clients