Disability Claims Examiner, Sr. jobs in New York
Disability Claims Examiner, Sr. 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, Sr. has contact with agents, claimants, and policy holders. Typically requires a bachelor's degree or its equivalent. Additionally, Disability Claims Examiner, Sr. typically reports to a supervisor/manager. To be a Disability Claims Examiner, Sr. typically requires 2 to 4 years of related experience. Gains exposure to some of the complex tasks within the job function. Occasionally directed in several aspects of the work. (Copyright 2024 Salary.com)
Recently Added Disability Claims Examiner, Sr. jobs
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
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. - 10 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...
- 12 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...
- 12 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...
- 12 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...
- 12 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
Disability Claims Examiner, Sr. jobs at Popular Companies
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- Dowbuilt
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Physician Assistant
- Loyal Source Government Services
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Audiologist
- Veterans Evaluation Services
-
Gary, IN
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Audiologist
- Loyal Source Government Services
-
Fremont, CA
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Dentist
- Veterans Evaluation Services
-
Grand Rapids, MI
- Your Role as a Provider As a clinician, you are an expert in the assessment, evaluation, and diagnosis of health conditi...
- 4/19/2024 12:00:00 AM
Human Resources Specialist - Full Performance Level
- National Reconnaissance Office (NRO)
-
Chantilly, VA
- WE ARE THE NRO For sixty years, the NRO has developed, acquired, launched and operated the satellites that are the found...
- 4/19/2024 12:00:00 AM
Environmental Health Safety Coordinator
- Compunnel Inc.
-
Columbia, TN
- Job Description The Health, Safety & Environmental Coordinator is responsible for: · Managing the Columbia Plant’s vario...
- 4/19/2024 12:00:00 AM
Short Term Disability Claims Examiner I, II or Sr - Remote
- USAble Life
-
Little Rock, AR
- * Short Term Disability Claims Experience Required* When it comes to making a meaningful difference in the lives of our ...
- 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 Disability Claims Examiner, Sr. jobs
$61,245 to $79,355
Most Popular Cities in New York for Disability Claims Examiner, Sr. Jobs
What does a Disability Claims Examiner, Sr. do?
Disability Claims Examiner, Sr. in Cleveland, OH
A disability claims examiner is a specialist who works for the Social Security Administration and whose job it is to determine if applicants for Supplemental Security Income or Social Security Disability Insurance are sufficiently disabled to receive benefits.
January 13, 2020
Disability Claims Examiner, Sr. in Oakland, CA
ULSTER COUNTY IS AN AFFIRMATIVE ACTION/EQUAL OPPORTUNITY EMPLOYER All qualified applicants will receive consideration for employment without regard to age, race, color, religion, gender, creed, national origin, physical or mental disability, marital status, veteran status, disabled veteran status, or status as a member of any other protected group or activity.
February 18, 2020
Disability Claims Examiner, Sr. in Des Moines, IA
A suitability determination by the Social Security Administration is necessary to determine whether an employee can be issued credentials in order to have access to Social Security disability data, records, and systems.
December 18, 2019