New York Licensed Claims Specialist

Job Summary

To support healthcare cost management, the full-time New York Licensed Claims Specialist will negotiate health care claims with providers to achieve maximum discounts and savings, while maintaining relationships and ensuring compliance with client guidelines, all in a remote work environment.

Key responsibilities

• Negotiate health care claims with providers to secure discounts and savings
• Research claims and communicate effectively with providers to facilitate negotiations
• Manage a high volume of claims, ensuring compliance with departmental performance metrics and client deadlines

Required qualifications

• Minimum high school diploma or GED
• At least 2 years of experience in a service-based industry, preferably in healthcare or medical insurance
• State licensure certification, including NY Health and/or P&C State Adjustor license, may be required
• Knowledge of medical coding systems (i.e., CPT, ICD-9/10) is desired
• Experience with standard medical insurance claim forms and office operations