New York Licensed Claims Specialist

Job Summary

A company is looking for a Claims Resolution Specialist.

Key Responsibilities

• Manage a high volume of healthcare claims to maximize savings opportunities while adhering to quality standards
• Perform provider research and address counteroffers to reach successful resolutions
• Update provider database and handle post-claim inquiries while 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 within six months of hire
• Knowledge of applicable laws for Workers' Compensation or auto medical bills is a plus
• Experience with standard medical insurance claim forms and general office operations