Claim Analyst

About the Role

Randstad is seeking a meticulous and dedicated Claim Analyst to join our team in Tampa, FL. This contract role, which has a 6-month term with the possibility of extension, is responsible for managing a caseload of dental and vision insurance claims, ensuring their accuracy, validity, and timely processing. In this position, you will also have the opportunity to be considered for an internal role with this team.

• Process claims according to company policies and procedures.
• Verify the accuracy of information entered into the claims system software.
• Review claims and attached documentation for completeness and accuracy to determine payment.
• Approve or deny claims, ensuring fees and proper authorizations are submitted.
• Resolve claims issues from the Customer Service department by researching claim situations and providing timely responses.
• Identify trends in provider or member issues and recommend solutions to management.
• Maintain the accuracy of member coverage information by reporting discrepancies to the membership department.
• Recommend improvements to workflow and organizational structure to enhance department productivity.
• Ensure the completeness and accuracy of Standard Operating Procedures by providing feedback to the department manager.
• Maintain all levels of member privacy in accordance with HIPAA standards.

• Strong attention to detail and analytical skills.
• Ability to follow documented policies and procedures.
• Experience in claims processing or a related field is a plus.
• Dental and Vision preferred.
• Excellent communication and problem-solving abilities.
• Knowledge of HIPAA standards and a commitment to maintaining patient privacy.