Claims Examiner jobs in New York, NY
Claims Examiner reviews, evaluates, and processes insurance claims and makes recommendations for resolution. Examines and authorizes insurance claims investigated by insurance adjusters. Being a Claims Examiner studies reports prepared by adjusters and similar claims to determine the extent of insurance coverage and validity of the claim. Communicates with agents, claimants, and policy holders. Additionally, Claims Examiner determines settlement according to organization practices and procedures. May require a bachelor's degree. Typically reports to a supervisor or manager. The Claims Examiner work is closely managed. Works on projects/matters of limited complexity in a support role. To be a Claims Examiner typically requires 0-2 years of related experience. (Copyright 2024 Salary.com)
Recently Added Claims Examiner jobs
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 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.
- 10 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
Claims Examiner Trainee (Custom Claims)
- Greater New York Mutual Insurance Company
-
Manhattan, NY
FULL_TIME
- Position Summary: The Custom Claim Examiner Trainee position is an entry-level position within Liability Claim Department. This opportunity is for those who desire to build a career in the field of Pr...
- Just Posted
Claims Examiner Trainee (Custom Claims)
- GREATER NEW YORK MUTUAL INSURANCE COMPANY
-
NEW YORK, NY
OTHER
- Job Details Level: Entry Job Location: NEW YORK HEADQUARTERS - NEW YORK, NY Salary Range: Undisclosed Job Category: Insurance DescriptionRequired to visit the NYC office one day per month. Position Su...
- 1 Month Ago
Claims Examiner, General Liability
- Crum & Forster
-
NEW YORK, NY
FULL_TIME
- Crum & Forster Company Overview Crum & Forster (C&F) with a proud history dating to 1822, provides specialty and standard commercial lines insurance products through our admitted and surplus lines ins...
- 6 Days Ago
Custom Liability Claims Examiner
- GNY Insurance Companies
-
New York, NY
FULL_TIME
- Job DetailsLevel ExperiencedJob Location NEW YORK HEADQUARTERS - NEW YORK, NYRemote Type HybridEducation Level 4 Year Degree Job Category Insurance Description Position Summary: To handle claims a...
- 8 Days Ago
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0 Claims Examiner jobs found in New York, NY area
Insurance Agent
- HealthMarkets
-
New York, NY
- HealthMarkets Overview If youre looking for an exciting opportunity where you can change peoples lives and achieve finan...
- 4/15/2024 12:00:00 AM
Insurance Agent
- HealthMarkets
-
Union City, NJ
- HealthMarkets Overview If youre looking for an exciting opportunity where you can change peoples lives and achieve finan...
- 4/15/2024 12:00:00 AM
Insurance Agent
- HealthMarkets
-
Yonkers, NY
- HealthMarkets Overview If youre looking for an exciting opportunity where you can change peoples lives and achieve finan...
- 4/15/2024 12:00:00 AM
Insurance Agent
- HealthMarkets
-
Paterson, NJ
- HealthMarkets Overview If youre looking for an exciting opportunity where you can change peoples lives and achieve finan...
- 4/15/2024 12:00:00 AM
Billing Coordinator
- Wilson Elser
-
White Plains, NY
- Job Description Job Description Wilson Elser's White Plains office currently seeks a Billing Coordinator to join a team ...
- 4/15/2024 12:00:00 AM
Claim Examiner
- Pyramid Consulting, Inc
-
Garden City, NY
- Immediate need for a talented Claim Examiner. This is a 6+ Months contract opportunity with long-term potential and is l...
- 4/13/2024 12:00:00 AM
Claims Examiner –Remote
- Generis Tek Inc
-
New York, NY
- Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
- 4/13/2024 12:00:00 AM
Claims Examiner –Remote
- Generis Tek Inc
-
Garden City, NY
- Please Contact: To discuss this amazing opportunity, reach out to our Talent Acquisition Specialist Abhinav Chakraborty ...
- 4/12/2024 12:00:00 AM
About New York, New York
The City of New York, usually called either New York City (NYC) or simply New York (NY), is the most populous city in the United States. With an estimated 2017 population of 8,622,698 distributed over a land area of about 302.6 square miles (784 km2), New York is also the most densely populated major city in the United States. Located at the southern tip of the state of New York, the city is the center of the New York metropolitan area, the largest metropolitan area in the world by urban landmass and one of the world's most populous megacities, with an estimated 20,320,876 people in its 2017 M...
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Claims Examiner jobs
$55,904 to $74,132
New York, New York area prices
were up 1.6% from a year ago
were up 1.6% from a year ago