Claims Director jobs in Huntington, NY

Claims Director directs and oversees the operations of an insurance claims department to meet operational, financial, and service requirements. Establishes policies and procedures for the administration of insurance claims for personal, property, or casualty loss based on coverage, appraisal, and verifiable damage. Being a Claims Director is responsible for the strategic processing and payment of claims. Maintains up-to-date- knowledge of legislation, regulations, and industry events which pertain to insurance claims. Additionally, Claims Director provides expert guidance and consultation to staff on the most complex claims. Requires a bachelor's degree. Typically reports to top management. The Claims 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 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
  • 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.
  • 16 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...
  • 18 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...
  • 30 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...
  • 1 Month Ago

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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

3
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...
  • 20 Days Ago

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0 Claims Director jobs found in Huntington, NY area

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Senior Manager, Corporate Insurance
  • Linde
  • Danbury, CT
  • As a Linde Insurance Manager, you will work to provide financial mitigation to Linde and its Directors for losses incurr...
  • 4/25/2024 12:00:00 AM

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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

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 Director jobs
$209,696 to $303,290
Huntington, New York area prices
were up 1.5% from a year ago

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Conducts audits of the claims process to include coverage analysis, investigation, valuation, scope, estimate, reserving and the accurate disposition of claims.
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