Claims Processing Director jobs in Huntington, NY

Claims Processing Director plans and directs one or more departments responsible for administration of health insurance claims, payment processing, billing research, and responding to inquiries. Establishes and implements organizational policies and procedures; may offer guidance on the appropriate handling of complex or high-value claims. Being a Claims Processing Director develops and executes strategic business plans for the department. Coordinates operations with other areas of the organization. Additionally, Claims Processing Director requires a bachelor's degree. Typically reports to top management. The Claims Processing Director manages a departmental sub-function within a broader departmental function. Creates functional strategies and specific objectives for the sub-function and develops budgets/policies/procedures to support the functional infrastructure. To be a Claims Processing Director typically requires 5+ years of managerial experience. Deep knowledge of the managed sub-function and solid knowledge of the overall departmental function. (Copyright 2024 Salary.com)

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Claims Examiner
  • Centers Plan for Healthy Living
  • 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 AND EXPERIENCE:
    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
    Preferred:
    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.
  • 22 Days Ago

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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...
  • 14 Days Ago

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Sterile Processing Technician
  • Northwell Careers
  • Huntington, NY FULL_TIME
  • Job Description Performs a variety of instrumentation decontamination, sterilization, packaging, inventory, and distribution tasks according to established department policies and procedures. Job Resp...
  • Just Posted

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Sterile Processing Technologist
  • Focus Staff Services
  • Huntington, NY OTHER
  • OverviewFocus Staff is seeking a Sterile Processing Technician for a travel contract in Huntington, NY. The ideal candidate will have 2 years of experience. Contract Length: 49 Start Date: 10/23/2023 ...
  • Just Posted

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Commerical Claims Adjuster
  • Network Adjusters
  • Farmingdale, NY FULL_TIME
  • Serving the insurance industry for almost six decades, Network Adjusters has built a reputation as a leading provider of insurance claims administration and independent adjusting services. We exemplif...
  • 24 Days Ago

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Claims Consultant - Multi-Line
  • General Placement Service
  • Melville, NY FULL_TIME
  • We’re looking for an experienced, customer-focused claims professional with a passion for helping others!Successful candidate will maintain a high-level of service and act as the liaison between insur...
  • 3 Days Ago

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0 Claims Processing Director jobs found in Huntington, NY area

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Claim Director - Complex Specialty
  • Axis
  • New York, NY
  • This is your opportunity to join AXIS Capital a trusted global provider of specialty lines insurance and reinsurance. We...
  • 3/29/2024 12:00:00 AM

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Claim Director-Westchester Casualty
  • Chubb
  • Jersey City, NJ
  • Job Description Scope The Westchester Casualty Claims Director is responsible for investigating and settling high exposu...
  • 3/29/2024 12:00:00 AM

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DIRECTOR, SNAP CLAIMS AND RECOVERY (SNAP-CR)
  • City of New York
  • New York, NY
  • Job Description The Investigation, Revenue, and Enforcement Administration (IREA) is responsible for supporting the inte...
  • 3/28/2024 12:00:00 AM

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Director of Claims Quality
  • AppleOne Employment Services
  • New York, NY
  • Our client is a large health plan located in NYC. The client is looking to hire a Director of Claims Quality. This perso...
  • 3/27/2024 12:00:00 AM

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Claims Director
  • Berkley
  • New York, NY
  • Company Details: Berkley Professional was founded in October 2008 as an operating unit of W. R. Berkley Corporation, one...
  • 3/27/2024 12:00:00 AM

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Claim Director-Environmental
  • Chubb
  • Jersey City, NJ
  • Job Description Chubb is seeking a Claim Director on the Environmental Claims team on a 3/2 hybrid work model. The Envir...
  • 3/27/2024 12:00:00 AM

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Associate Director, Retail Claims Technology Solutions
  • Humana
  • Jersey City, NJ
  • Associate Director, Retail Claims Technology Solutions in Jersey City , New Jersey **Description** The Associate Directo...
  • 3/25/2024 12:00:00 AM

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Healthcare Compliance Analyst
  • Momentum Resource Solutions
  • New York, NY
  • Job Description Job Description We are seeking a Healthcare Complaince Analyst to become a part of our organization! You...
  • 3/25/2024 12:00:00 AM

The Town of Huntington is one of ten towns in Suffolk County, New York, United States. Founded in 1653, it is located on the north shore of Long Island in northwestern Suffolk County, with Long Island Sound to its north and Nassau County adjacent to the west. Huntington is part of the New York metropolitan area. As of the United States 2010 Census, the town population was 203,264....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Processing Director jobs
$180,731 to $242,861
Huntington, New York area prices
were up 1.5% from a year ago

Claims Processing Director in Portsmouth, NH
Insurance claims and processing clerks work closely with insurance brokers and agents, handling the administrative duties behind insurance policy renewals, claims processing and new policies.
December 28, 2019
Claims Processing Director in Santa Barbara, CA
Complete with new dashboards, reporting functionality, business intelligence tools, and improved security, FileHandler Enterprise is the new benchmark for Claims Management Software.
February 08, 2020
Claims Processing Director in San Diego, CA
Pulpstream makes it possible for you to have one system for tracking all claims.
January 07, 2020