Disability Claims Examiner jobs in New York

Disability Claims Examiner reviews, evaluates and processes disability insurance claims according to procedure and practice. Examines claims material to ensure insurance coverage and validity. Being a Disability Claims Examiner has contact with agents, claimants, and policy holders. Typically requires a bachelor's degree or its equivalent. Additionally, Disability Claims Examiner typically reports to a supervisor/manager. To be a Disability Claims Examiner typically requires 0-2 years of related experience. Works on projects/matters of limited complexity in a support role. Work is closely managed. (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.
  • 21 Days Ago

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Examiner of Claims
  • City of Syracuse
  • Syracuse, NY FULL_TIME
  • **Equal Opportunity Employer-Women & Minorities are strongly encouraged to apply.** The City of Syracuse Department of Financial Operations (Division of Finance) is currently looking for qualified can...
  • 22 Days Ago

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Claims Examiner
  • Nassau
  • East Greenbush, NY FULL_TIME
  • Job Summary The primary focus of this position is the adjudication of all death, disability, and medical claims. Principal Duties and Responsibilities Adjudicates Traditional Life, Variable Life, and ...
  • 24 Days Ago

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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 oppor...
  • 13 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...
  • 13 Days Ago

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Claims Examiner
  • Centers Plan for Healthy Living
  • Staten Island, 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...
  • 15 Days Ago

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Rebate Analyst
  • Daikin Comfort
  • Waller, TX
  • REBATE ANALYST 1 (Temporary Position) The Opportunity Daikin Comfort Technologies Manufacturing, L.P. is seeking a skill...
  • 3/28/2024 12:00:00 AM

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Behavioral Health Counselor- Eunice, LA
  • HAART, Inc.
  • Baton Rouge, LA
  • Job Purpose: The Behavioral Health Counselor will conduct patient assessments, implement therapeutic interventions, comp...
  • 3/28/2024 12:00:00 AM

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INSPECTOR II - STRUCTURAL
  • City of Plantation, FL
  • Fort Lauderdale, FL
  • Salary: $68,012.86 - $108,820.57 Annually Location : Plantation, FL Job Type: Full time Job Number: 476-06 Department: B...
  • 3/28/2024 12:00:00 AM

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POLICE OFFICER - PRESERVICE
  • City of Riverside, CA
  • Riverside, CA
  • Salary : $93,360.00 - $119,124.00 Annually Location : Riverside, CA Job Type: Full-time Job Number: 24-2240-01 Departmen...
  • 3/28/2024 12:00:00 AM

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Registered Nurse - 60010621
  • Florida Department of Transportation
  • Macclenny, FL
  • Requisition No: 806536 Agency: Children and Families Working Title: REGISTERED NURSE - 60010621 Position Number: 6001062...
  • 3/28/2024 12:00:00 AM

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REGISTERED NURSE SPECIALIST - 60042430
  • MyFlorida
  • Macclenny, FL
  • REGISTERED NURSE SPECIALIST - 60042430 Date: Feb 24, 2024 Location: MACCLENNY, FL, US, 32063 The State Personnel System ...
  • 3/28/2024 12:00:00 AM

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Registered Nurse Specialist - 60042430
  • State of Florida
  • Macclenny, FL
  • Requisition No: 539008 Agency: Children and Families Working Title: REGISTERED NURSE SPECIALIST - 60042430 Position Numb...
  • 3/28/2024 12:00:00 AM

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Deputy Fire Chief - Operations
  • City of Copperas Cove
  • Copperas Cove, TX
  • DEFINITION / GENERAL PURPOSE: Performs a variety of administrative, supervisory, and technical work in the supervision a...
  • 3/28/2024 12:00:00 AM

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 Disability Claims Examiner jobs
$53,216 to $66,070