New York Licensed Claims Specialist

Job Summary

A company is looking for a Claims Resolution Specialist responsible for negotiating healthcare claims to maximize discounts and savings for clients.

Key Responsibilities

• Manage high volumes of 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 databases and handle post-claim inquiries, ensuring compliance with HIPAA protocols

Required Qualifications, Training, and Education

• 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, with a six-month timeline to obtain if not already certified
• Knowledge of applicable laws and general office operations related to medical insurance claims
• Ability to work independently and handle confidential information in a standard office environment