New York Licensed Claims Specialist

Job Summary

A company is looking for a Medical Claims Resolution Specialist II.

Key Responsibilities

• Manage healthcare claims to maximize savings by contacting providers and presenting proposals
• Perform provider research and address counteroffers to achieve resolution while adhering to guidelines
• Update provider database and handle post-claim inquiries, ensuring compliance with HIPAA protocols

Required Qualifications

• Minimum high school diploma or GED
• At least 6 months of experience in the healthcare industry; 1 year preferred
• State licensure certification may be required and must be obtained within six months if not already held
• Knowledge of general office operations and standard medical insurance claim forms
• Ability to work independently and handle confidential information