New York Licensed Claims Specialist

Job Summary

To support healthcare cost management, the full-time New York Licensed Claims Specialist will negotiate with healthcare providers on eligible claims to maximize discounts and savings while maintaining high-quality standards and compliance with client guidelines.

Key responsibilities

• Manage a high volume of healthcare claims by contacting providers to negotiate savings and present proposals
• Perform provider research and address counteroffers to achieve successful resolutions on claims
• Ensure compliance with HIPAA protocols while maintaining departmental performance metrics

Required qualifications

• Minimum high school diploma or GED
• At least 6 months of experience in the healthcare industry, such as provider billing or medical coding
• State licensure certification, including NY Health and/or P&C State Adjustor license, may be required
• Knowledge of applicable laws and statutes related to Workers' Compensation or automobile medical bills is a plus
• Proficiency in using software related to job responsibilities, including MS Word and Excel