Job Ref: TE0167
Category: Claims
Department: CLAIMS
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $55,000.00 - $64,518.00
Position Overview
The Claims Service Correspondent is responsible for accurate and timely responses to written claim inquiries received from providers. This individual provides support regarding the adjudication and adjustment of claims for multiple lines of business. They will work closely with Provider Contracting, Medical Management, Enrollment and Membership department, and Claims Processing unit.
Scope of Role & Responsibilities
Act as a key liaison and service representatives for all written provider inquiries and problem resolution.
Respond to all claim inquiries from provider sites including physicians, clinical staff, and site administrators.
Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., Claims, Utilization Management, etc.)
Manage and ensure appropriate follow-up and closure for all inquiries.
Respond to providers’ inquiries in writing and maintain accurate tracking.
Data entry into the Claims Processing and Correspondence Distribution systems.
Perform claim adjustments to correct erroneous payments (overpayments/underpayments).
Perform claim adjustments due to Authorization Appeals and Retro Reviews.
Participate in special projects involving Claim Status Investigations.
Resolve Member Bills referred from Member Services.
Required Education, Training & Professional Experience
High School Diploma required.
Minimum 2 years of experience in claims processing protocols and payment schemes.
Proficiency working in a comparable Claims Processing Database.
Thorough knowledge of health benefits plans.
Must be able to resolve concerns with providers in a professional manner.
Professional Competencies
Integrity and Trust
Customer Service Focus
Functional/Technical skills
Written/Oral Communication
#LI-Hybrid
#MHP50
...Aviation is an innovative aerospace startup based in Ohio and specializes in developing tail-sitter drones. We are seeking a Remote Drone Pilot to support the testing and operations of our unique aircraft. In this role, you will be responsible for preparing, conducting...
...Join the Plum Market Team Where Passion Meets Opportunity! Plum... ...growing leader in the Grocery, Food & Beverage Retail industry. We... ...apply and discover how you can be part of our team! Why Work at Plum... ...Flexible Scheduling Full-time and part-time positions available...
...Job Description Kitchen Designers at The Home Depot help customers turn their kitchen and bath dreams into reality. Kitchen Designers greet and engage customers, listen to their needs, and guide them through the design process-offering 'good, better, best' options, samples...
...Job Description Job Description Responsibilities Assemble components according to work instructions and established procedures. Operate basic hand and power tools, including drills and impact drivers. Read tape measures and use digital calipers as needed....
...techniques and methods of installation and construction.Advanced techniques with woodworking machineries like Bandsaw, drill press, and bench grinder.Ability to cut, fit, and then install the wooden material according to specific measurements making sure corners are crisp,...