Claims Clerk, Sr. jobs in Huntington, NY

Claims Clerk, Sr. 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, Sr. verifies coverage eligibility. Calculates settlement amounts according to guidelines. Additionally, Claims Clerk, Sr. processes routine claim payments. Requires a high school diploma or equivalent. Typically reports to a supervisor. The Claims Clerk, Sr. works under moderate supervision. Gaining or has attained full proficiency in a specific area of discipline. To be a Claims Clerk, Sr. typically requires 1-3 years of related experience. (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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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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Clerk
  • Uncle Giuseppe's
  • Melville, NY FULL_TIME
  • Are you a coffee lover? We are at Uncle Giuseppe's! We have an exciting opportunity for a PT Espresso Clerkat ourMelville Store. Bring your cheerful, customer service and teamwork attitude to our coff...
  • 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...
  • 23 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...
  • 2 Days Ago

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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...
  • 17 Days Ago

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0 Claims Clerk, Sr. jobs found in Huntington, NY area

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Senior GL/ Construction Defect Claims Adjuster - Remote
  • NARS
  • New York, NY
  • Job Description Job Description Handle a case load of approximately 120 pending multi-jurisdictional construction defect...
  • 3/28/2024 12:00:00 AM

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Cyber Claims Adjuster New York
  • Arcus Search Ltd
  • New York, NY
  • LivIcons Evolution **Location:** New York A leading specialist insurance provider headquartered in London are looking fo...
  • 3/28/2024 12:00:00 AM

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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...
  • 3/28/2024 12:00:00 AM

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Sr. General Liability Claims Adjuster - NY Adjusters License a Plus
  • North American Risk Services, Inc. (NARS)
  • New York, NY
  • Job Description Job Description Sr. General Liability Claims Adjuster – Active New York Adjusters License A PLUS Work-Fr...
  • 3/28/2024 12:00:00 AM

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Senior Consultant, Consulting, Kroll Restructuring Administration
  • Kroll
  • New York, NY
  • Job Description In a world of disruption and increasingly complex business challenges, our professionals bring truth int...
  • 3/28/2024 12:00:00 AM

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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...
  • 3/27/2024 12:00:00 AM

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Claims Administrator
  • Barasch & McGarry
  • New York, NY
  • Job Description Job Description Purpose Timely processing and managing of clients' Victim Compensation Fund, “VCF”, clai...
  • 3/26/2024 12:00:00 AM

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Auto PD Claims Adjuster - NY Adjusters License Needed - Remote
  • North American Risk Services, Inc. (NARS)
  • New York, NY
  • Job Description Job Description Auto PD Claims Adjusters – Commercial Auto/Commercial Trucking · Must Have active New Yo...
  • 3/26/2024 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 Clerk, Sr. jobs
$48,951 to $61,893
Huntington, New York area prices
were up 1.5% from a year ago

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The basic purpose of small claims court is to help individuals recover small amounts of money quickly, informally, and relatively inexpensively, and without hiring a lawyer; but if you don’t use a lawyer, you still must be able to prove your case.
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When you’re in the beginning stages of writing your insurance claims processing clerk job description, you’ll need to review common qualifications for this job.
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A recent court filing by federal prosecutors shows employees of Cook County Circuit Court Clerk Dorothy Brown detailing hiring practices in the clerk’s office that suggest a questionable pattern of “pay to play” arrangements.
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