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 Analyst responsible for managing, reviewing, and processing reimbursement requests within the health benefits sector. The role requires acting as a critical liaison between internal teams, insurance carriers, third-party administrators (TPAs), and clients to ensure accuracy, compliance, and efficiency in claim resolution. This position offers a comprehensive training program and opportunities for professional growth.
Key Responsibilities
- Review reimbursement requests for accuracy and completeness; submit verified claims to insurance carriers following company and regulatory guidelines.
- Monitor outstanding claims, maintaining detailed tracking logs and pursuing carriers for timely financial reimbursements.
- Oversee and update monthly claim reports for a designated book of business.
- Evaluate plan eligibility documentation and coordinate necessary internal and external approvals.
- Distribute reimbursements, convey updates to stakeholders, and assist with year-end account closeouts and reconciliations.
- Maintain professional, clear, and proactive correspondence via phone and email with carriers, brokers, TPAs, and clients.
- Partner closely with the Claims Manager and Claims Lead.
Qualifications
- Prior experience in health insurance claims processing or medical claims management.
- Strong proficiency in data tracking, documentation management, and financial/claim report reconciliation.
- Strong Excel proficiency.
- Ability to learn and operate within claims systems and structured workflows.
- Prior experience working with self-funded health plans is preferred.
- Familiarity with Stop Loss insurance is preferred, but comprehensive training is provided.
Skills
- Technical Skills: Proficiency with Excel and claims systems.
- Soft Skills: Strong communication, documentation management, and data tracking abilities.
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.
*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
