Claims Examiner jobs in New York
Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
Recently Added Claims Examiner jobs
Claims Examiner
- Centers Plan for Healthy Living
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Farmingdale, NY
FULL_TIME
-
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.
Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career.
JOB SUMMARY:
Responsible for the timely and accurate adjudication of all claims for Centers Plan for Healthy Living (CPHL) products. Reviews and resolves pended and corrected claims. Analyzes claim resubmissions to determine areas for provider education or system re-configuration. Serve as the primary point of contact for claim issues raised by Providers and internal CPHL departments. Provides feedback on department workflows and identifies opportunities for redesign. Performs claims testing to ensure that systems are designed efficiently based on the Plan's benefit structure.
PRIMARY RESPONSIBILITIES:
- Review, research and finalize provider claims within established regulatory requirements and CPHL policies.
- Analyze provider issues and collaborate with other departments to resolve. Identifies and documents opportunities for provider education.
- Review provider disputes or appeals and provide a detailed analysis of findings.
- Conduct claim testing for CPHL products.
- Review claim processing results of Delegated Vendors
- Provides expertise and assistance relative to provider billing and payment guidelines consistent with CPHL policies and procedures and State or CMS guidelines.
- Document all provider contacts; including telephonically, emails, written correspondence
- Trouble shoot and identify root cause of problems and participate in developing solutions
- Provides follow up and intervention relating to provider claim inquiries
- Collaborate with internal teams and departments to ensure applications are processed, contracts are executed and all providers are credentialed in a timely manner.
- Participates in standing meetings as necessary, including but not limited to provider relations, contracting, network development, team building.
- Performs other duties and special projects as assigned and directed.
Education
Required: BA/BS degree in a financial field or equivalent healthcare experience
Preferred:
Type of Experience
Required: 3 years of claim processing experience, preferably in a Medicaid/Medicare, MLTC environment, Customer Service in health insurance product environment.
Preferred:
Specific Technical Skills
Required: Use of Microsoft Access or similar query tool. Proficiency with MS applications, including but not limited to Word, Excel, Outlook, Power Point, Project
Strong telephonic and customer service skills
Certifications/Licensure:
Required: n/a
Knowledge and Skills:
- Effective presentation skills
- Excellent verbal and written communication skills
- Must be able to participate in meetings with all levels of management within the organization
- Detail oriented, excellent follow up
- Ability to multi-task in a fast paced environment
- Must be service oriented, quick learner, team player
- Appreciation of cultural diversity and sensitivity toward target population
SCOPE INFORMATION
# Direct Reports: n/a
PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.
Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment. - 9 Days Ago
Claims Examiner
- Centers Plan for Healthy Living/Centers Care Solutions
-
Garden, NY
FULL_TIME
- Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with oppor...
- 11 Days Ago
Claims Examiner
- Centers Plan for Healthy Living/Centers Care Solutions
-
Staten Island, NY
FULL_TIME
- Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with oppor...
- 11 Days Ago
Claims Examiner
- Centers Plan for Healthy Living/Centers Care Solutions
-
Farmingdale, NY
FULL_TIME
- Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with oppor...
- 11 Days Ago
Claims Examiner
- Centers Plan for Healthy Living
-
Garden, NY
FULL_TIME
- Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance a...
- 11 Days Ago
Claims Examiner
- Health Center, Inc.
-
New York, NY
FULL_TIME
- An established health services organization based in New York City has an immediate opening for a Claims Clerk – Customer Services. Our ambulatory care facilities are staffed with a wide range of heal...
- 1 Month Ago
Claims Examiner jobs at Popular Companies
Claim Examiner
- Pyramid Consulting, Inc
-
Garden City, NY
- Immediate need for a talented Claim Examiner. This is a 6+ Months contract opportunity with long-term potential and is l...
- 4/18/2024 12:00:00 AM
Claim Examiner
- Kansas City Life Insurance Company
-
Kansas City, MO
- QUALIFICATIONS/REQUIREMENTS: Bachelor of Arts or Sciences degree in business field, related field, or equivalent work ex...
- 4/17/2024 12:00:00 AM
Claims Examiner
- The Jonus Group
-
Chicago, IL
- We are seeking a Senior Claims Examiner to join our team. The Senior Claims Examiner will play a pivotal role in managin...
- 4/17/2024 12:00:00 AM
Claims Examiner
- The Jonus Group
-
New York, NY
- We are seeking a Senior Claims Examiner to join our team. The Senior Claims Examiner will play a pivotal role in managin...
- 4/17/2024 12:00:00 AM
Claims Examiner
- The Jonus Group
-
Phoenix, AZ
- We are seeking a Senior Claims Examiner to join our team. The Senior Claims Examiner will play a pivotal role in managin...
- 4/17/2024 12:00:00 AM
Claims Examiner
- D3 Search
-
Los Angeles, CA
- D3 Search is actively seeking the following Claims Examiner II - Cyber candidate for a global insurer with a growing off...
- 4/17/2024 12:00:00 AM
Claims Examiner
- The Jonus Group
-
Atlanta, GA
- We are seeking a Senior Claims Examiner to join our team. The Senior Claims Examiner will play a pivotal role in managin...
- 4/17/2024 12:00:00 AM
Claims Examiner
- APR Consulting
-
Whittier, CA
- APR Consulting, Inc. has been engaged to identify a Claims Examiner Location: Whittier, CA 90601 Position: Claims Examin...
- 4/17/2024 12:00:00 AM
About New York
New York is a state in the Northeastern United States. New York was one of the original thirteen colonies that formed the United States.
New York covers 54,555 square miles (141,300 km2) and ranks as the 27th largest state by size.[3] The highest elevation in New York is Mount Marcy in the Adirondacks, at 5,344 feet (1,629 meters) above sea level; while the state's lowest point is at sea level, on the Atlantic Ocean.
In contrast with New York City's urban landscape, the vast majority of the state's geographic area is dominated by meadows, forests, rivers, farms, mountains, and lakes. Most of...
Source: Wikipedia (as of 04/17/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$51,022 to $67,658