Medical Claims Specialist

Location: Miami, FL

Pay Rate: $20.00 – $25.00 / hour (Depending on experience)

Position Type: Full-Time, Temporary

Work Arrangement: 4/1 Hybrid Schedule (4 days in-office / 1 day remote)

Schedule: Monday – Friday, 8-Hour Shifts (Flexible start times at 8:00 AM, 8:30 AM, or 9:00 AM)

A leading global reproductive health, genetic testing, and diagnostic laboratory facility in Miami is seeking a self-directed, detail-oriented Medical Claims Specialist to join their revenue cycle team. This role is vital to managing payor follow-up, clearing backlogs, and ensuring accurate reimbursement for complex diagnostic and laboratory services.

• Experience:
  
  2–3+ years of hands‑on medical claims or revenue cycle experience.
• Denials Expertise:
  Direct experience with denial management, corrected claims, and the appeals process.
• Payer Knowledge:
  Broad understanding of commercial insurance plans, payer processes, EOB/ERA breakdown, and timely filing rules.
• Technical
  
  Skills:
  
  Proficiency navigating payer portals and multiple electronic billing systems.
• Work Ethic:
  Comfortable working through backlogs, adaptable to project‑based tasks, and accustomed to meeting measurable productivity goals.

Pay Rate: $20 - $25 per hour

Shift: First

Work Hours: 9 AM - 5 PM

Education: High School

• Claims Processing & Follow-Up: Perform medical claims billing, payer follow-up, and continuous claim status calls to ensure timely reimbursement.
• Denials & Appeals: Manage denial resolution, submit corrected claims, and draft reconsiderations and formal appeals. (Denial management and appeals experience is especially valuable for this role.)
• Verification & Authorizations: Handle insurance eligibility verification and manage prior authorization requests and follow‑ups.
• EOB & Code Analysis: Review Explanation of Benefits (EOBs) / Electronic Remittance Advices (ERAs), analyze denial reason codes, and identify payment variances or underpayments.
• AR & Timely Filing: Work aging AR reports and strictly adhere to timely filing requirements across various commercial insurance plans and payer processes.
• System Operations: Navigate multiple payer portals and billing systems, accurately documenting all account activity.

• Medical Claims (2 years of experience is preferred)
• Payer Processes (2 years of experience is preferred)
• Denials and Appeals (2 years of experience is preferred)
• AR Billing (2 years of experience is preferred)

• Years of experience: 2 years
• Experience level:
  Experienced

Equal Opportunity

Employer:

Race, Color, Religion, Sex, Sexual Orientation, Gender Identity, National Origin, Age, Genetic Information, Disability, Protected Veteran Status, or any other legally protected group status.

At Randstad, we welcome people of all abilities and want to ensure that our hiring and interview process meets the needs of all applicants. If you require a reasonable accommodation to make your application or interview experience a great one, please contact

Pay offered to a successful candidate will be based on several factors including the candidate's education, work experience, work location, specific job duties, certifications, etc. In addition, Randstad offers a comprehensive benefits package, including: medical, prescription, dental, vision, AD&D, and life insurance offerings, short-term disability, and a 401K plan (all benefits are based on eligibility).

This posting is open for thirty (30) days.

• Experienced
• 2 years

• High School (required)