Job Description

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 is a leading minority-owned professional and technical recruitment and staffing advisory organization. We are comprised of specialized practices focusing on a variety of skill sets and industries. Having a depth and breadth of industry expertise, our subject matter experts are able to provide tailored and swift sourcing solutions to fulfill client hiring needs. In other words, we connect top talent with companies. We are the staffing arm of the Pride Global network, a minority-owned integrated human capital solutions firm, with additional offerings in vendor management, payroll programs, and business process optimization.

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

Equal Employment Opportunity

Russell Tobin is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment

Russell Tobin is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

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