Claims Processing Director jobs in Levittown, 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/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 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.
  • 18 Days Ago

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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...
  • 18 Days Ago

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Claims Analyst
  • Primma, LLC
  • Roslyn, NY FULL_TIME
  • Essential Duties & Responsibilities: Follow claims handling guidelines for all facets of claims handling, including but not limited to, claims documentation, diary, reserve adequacy, data entry, elect...
  • Just Posted

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Claims Advocate
  • World Insurance Associates, LLC.
  • Cedarhurst, NY FULL_TIME
  • SummaryWorld Insurance Associates is a unique insurance organization offering top products and services from major providers, combined with attentive service from local agents.Founded in 2011, World i...
  • 6 Days Ago

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Claims Advocate
  • Foundation Risk Partners
  • Hyde Park, NY FULL_TIME
  • Foundation Risk Partners, one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Claims Advocate to their Genatt V team in New Hyde Park, NY. Job Summary: Act as a ...
  • 26 Days Ago

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Claims Specialist
  • Foundation Risk Partners
  • Rockville Centre, NY FULL_TIME
  • Foundation Risk Partners, one of the fastest growing insurance brokerage and consulting firms in the US, is adding a Claims Specialist to their growing team at the Durnan Group in Rockville Centre, NY...
  • 27 Days Ago

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0 Claims Processing Director jobs found in Levittown, NY area

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Director of Claims Quality
  • Tandym Group
  • Jersey City, NJ
  • A health services organization in New York City is currently seeking an experienced professional to join their staff as ...
  • 4/24/2024 12:00:00 AM

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IT Project Manager with P&C Insurance
  • REQ Solutions
  • New York, NY
  • Job Title: IT Project Manager with P&C Insurance Location: New York, NY 10022 (Work from home) Duration: 6 months to sta...
  • 4/24/2024 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...
  • 4/24/2024 12:00:00 AM

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General Liability Adjuster
  • Network Adjusters, Inc.
  • Farmingdale, NY
  • Network Adjusters, Inc. is a third-party administrative commercial lines handling company. Serving the insurance industr...
  • 4/23/2024 12:00:00 AM

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Director, Kyndryl Consult Partner Insurance Industry - Remote US NY
  • Kyndryl
  • New York, NY
  • Who We Are At Kyndryl, we design, build, manage and modernize the mission-critical technology systems that the world dep...
  • 4/23/2024 12:00:00 AM

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Complex Claims Director, Excess
  • AIG
  • Jersey City, NJ
  • Complex Director- Excess Major Claims | Primary Severity Unit Who we are American International Group, Inc. (AIG) is a l...
  • 4/21/2024 12:00:00 AM

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Managing Director in Insurance
  • Sia Partners
  • New York, NY
  • Sia Partners is a next-generation management consulting firm. We offer a unique blend of AI and design capabilities, aug...
  • 4/21/2024 12:00:00 AM

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Senior Management Liability Underwriter (Level III Or AVP, Level IV)
  • Zurich Insurance Company Ltd.
  • New York, NY
  • Zurich E&S Financial Lines is currently looking to hire an experienced Senior Underwriter to join our Wholesale Public, ...
  • 4/20/2024 12:00:00 AM

Levittown, New York is an unincorporated area in Nassau County, New York. It can be defined in three overlapping but non-conforming ways. The most common use is Levittown as defined by the United States Postal Service Zip Code 11756. Another definition is the extent of the Levitt & Sons development built from 1947 to 1951. A third is the Census Designated Place (CDP) called Levittown as defined by the US Census Bureau. The United States Postal Service ZIP code called Levittown, New York is 11756 and what is most commonly used to mean Levittown, New York. It does not include all the houses ...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Processing Director jobs
$173,996 to $233,816
Levittown, New York area prices
were up 1.6% 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