Medical Claims Adjuster

We are looking for a detail-oriented Medical Claims Adjuster to join a mission-driven organization serving employee benefit trust funds in Pleasanton, California. This contract opportunity with permanent potential is ideal for someone who thrives in a fast-paced claims environment and can balance accuracy, responsiveness, and sound judgment. In this role, you will support the administration of health and welfare benefits by reviewing medical claims, addressing inquiries, and helping ensure compliance with plan guidelines and industry standards.

Medical Claims Adjuster Responsibilities:

• Review and process medical claims with a high degree of accuracy while applying plan provisions, coding standards, and established benefit rules.

• Support the delivery of union-sponsored health and welfare benefit programs by handling claim activity in a timely and consistent manner.

• Provide clear guidance to members, dependents, providers, and vendors regarding benefits, claim outcomes, and administrative procedures.

• Investigate claim discrepancies and coordinate with internal departments and external partners to resolve issues efficiently.

• Compile claim-related data, prepare routine reports, and contribute to projects that improve administrative operations.

• Handle documentation requests and assist with responses to legal or compliance-related inquiries, including subpoenas when needed.

• Confirm and maintain eligibility information by working with network vendors and associated benefit partners.

• Monitor updates to medical coding, coverage policies, and regulatory requirements to support compliant claims adjudication.

• Maintain organized records and safeguard sensitive information in accordance with confidentiality standards.

• Perform other duties as needed to support the claims team and broader benefits administration function.

If you are interested in this Medical Claims Adjuster position, please apply today!

Qualifications:

• At least 2 years of experience in medical claims processing combined with customer service responsibilities.
• Working knowledge of medical coding concepts, including ICD-10, CPT, outpatient coding, and medical insurance billing practices.
• Strong analytical and organizational skills with the ability to identify issues and complete work accurately.
• Effective written and verbal communication skills for interacting with members, providers, vendors, and internal teams.
• Proficiency in Microsoft Office applications, including Outlook, Excel, and Word.
• Ability to manage multiple deadlines in a high-volume setting while remaining composed and attentive to detail.
• High level of discretion when handling confidential records and sensitive benefit information.
• Bilingual Spanish skills and familiarity with call center platforms are preferred.

Compensation

$33.00-$36.00 Hourly

About Us

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All applicants applying for U.S. job openings must be legally authorized to work in the United States. Benefits are available to contract/temporary professionals, including medical, vision, dental, and life and disability insurance. Hired contract/temporary professionals are also eligible to enroll in our company 401(k) plan. Visit roberthalf.gobenefits.net for more information.

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