Claims Clerk jobs in Huntington, NY
Claims Clerk reviews insurance claim forms and supporting documents for completeness and accuracy and obtains missing information as necessary. Inputs claim information into system for processing. Being a Claims Clerk verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk works under the close direction of senior personnel in the functional area. Possesses a moderate understanding of general aspects of the job. May require 0-1 year of general work experience. (Copyright 2024 Salary.com)
Recently Added Claims Clerk 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
-
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 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...
- 24 Days Ago
Claims Intern (Summer 2024)
- Careers
-
Plainview, NY
INTERN
- Who We Are NFP is a seven-time Best Places to Work award winner in Business Insurance who has also earned the 5-Star Diversity, Equity and Inclusion (DEI) award from Insurance Business magazine and th...
- 1 Month Ago
Workers Compensation Claims Analyst
- World Insurance Associates, LLC.
-
Syosset, 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...
- 2 Months Ago
Dental Claims billing and payment processing analyst
- 3rd Party Administrator
-
Melville, NY
FULL_TIME
- The work environment is friendly and very team oriented and we love what we do. Dental Claims processor including customer service duties a must. Need to have a complete understanding of CDT dental co...
- 14 Days Ago
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0 Claims Clerk jobs found in Huntington, NY area
General Liability Adjuster
- Network Adjusters, Inc.
-
Farmingdale, NY
- Network Adjusters, Inc. is a third-party administrative commercial lines handling company. Serving the insurance industr...
- 4/18/2024 12:00:00 AM
Associate Counsel, P&C Insurance Fronting Contract Drafting/Negotiating (Remote, East Coast preferred))
- Response Companies
-
New York, NY
- Associate Counsel, P&C Insurance Fronting Contact Drafting/Negotiating experience (5-7 years) Fully REMOTE role with min...
- 4/18/2024 12:00:00 AM
Operations Manager
- Pure Power Engineering
-
Hoboken, NJ
- Job Type Full-time Description Pure Power Engineering is seeking a highly experienced, analytical, and forward-thinking ...
- 4/18/2024 12:00:00 AM
Sr. General Liability Claims Adjuster- NY Adjuster Lic a Must -Remote
- NARS
-
New York, NY
- Job Description Job Description We are seeking a Senior General Liability Claims Adjuster- (Labor Law a must ) to become...
- 4/17/2024 12:00:00 AM
Legal Billing Assistant
- Harrington, Ocko & Monk LLP
-
White Plains, NY
- Job Description Job Description Harrington, Ocko & Monk, LLP is a sophisticated regional law firm conveniently located i...
- 4/17/2024 12:00:00 AM
Claims Administrative Assistant
- Brandon J. Broderick, Attorney At Law
-
River Edge, NJ
- Job Description Job Description A prominent law firm based in Bergen County, NJ, is seeking an experienced Claims Admini...
- 4/16/2024 12:00:00 AM
Operations Manager
- Barasch & McGarry
-
New York, NY
- Job Description Job Description PURPOSE: Under the direction of the Director of Operations, the Operations Manager will ...
- 4/14/2024 12:00:00 AM
Auto PD Claims Adjuster - Commercial - NY Adjusters License Needed
- NARS
-
New York, NY
- Job Description Job Description Auto PD Claims Adjusters – Commercial Auto/Commercial Trucking · Must Have active New Yo...
- 4/14/2024 12:00:00 AM
About Huntington, New York
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 Clerk jobs
$41,751 to $52,825
Huntington, New York area prices
were up 1.5% from a year ago
were up 1.5% from a year ago