NY Licensed Claims Specialist

Job Summary

To achieve maximum discounts on healthcare claims, the full-time NY Licensed Claims Specialist will manage high volumes of claims by negotiating with providers, conducting research, and ensuring compliance with client guidelines while maintaining performance metrics.

Key responsibilities

• Contact healthcare providers to negotiate discounts on assigned claims and present proposals for resolution
• Perform provider research and address counteroffers to achieve desired savings
• Maintain and update the provider database while ensuring compliance with HIPAA protocols

Required qualifications

• Minimum high school diploma or GED
• At least 6 months of experience in the healthcare industry, with 1 year preferred
• State licensure certification, including NY Health and/or P&C State Adjustor license, may be required
• Knowledge of applicable laws and statutes related to healthcare claims
• Experience with standard medical insurance claim forms and general office operations