Claims Data Specialist – MSP & QNXT

1199seiu; New York, Northern (NY, KY); Hybrid; USD 38,000 - 52,000; Full time

Job summary

1199SEIU is seeking a detail‑oriented clerical professional to support the Hospital Claims Department. You will maintain accurate data for member information in the QNXT system and ensure timely processing of inquiries for adjustments through DMS.

The role involves scanning and archiving documents, handling reconsideration letters, and coordinating with internal departments and external providers. Strong data entry and communication skills are essential.

Qualifications

• High School Diploma or GED required; some College preferred
• Minimum two years of clerical experience in a general office environment required
• Strong data entry skills and attention to detail
• Knowledge of hospital claims system (QNXT) is a plus
• Excellent oral and written communication skills
• Demonstrated organizational skills with ability to multi-task and follow up

Responsibilities

• Maintain accurate data entry of 199SEIU member information in hospital claims processing system (QNXT)
• Track and ensure completeness of daily inquiries; ensure they are sent to appropriate payment area for adjustment including but not limited to DMS (Data Management System)
• Prepare MSP (Medicare Secondary Payer) claims/rebuttals, scan and archive supporting documents
• Scan and archive documents into DMS (Data Management System)
• Mail and maintain reconsideration letters including maintaining of acknowledgement of reconsideration letters
• Track misdirected provider inquiries received from internal departments within the Fund, enter memo into QNXT and upload document to DMS (Data Management System)
• Handle claim pending with edits for preparation of external transmission files, including review of aged edit(s), retrieval, and assignment of determination of incoming transmission files, follow up, sort and data entry of transmission files related information as needed
• Review and maintain daily utilization management of claims and/or documents to ensure information is accurate and loaded in the claims system are correct, including updating memos and internal tracking logs with determination
• Maintain monthly invoice report to ensure information is accurate and determinations loaded into claims processing system are correct; including updating memos of provider inquiries and medical records received, revised DRG received as well as claims processing/payment information; update internal spreadsheet tracker with claim determination
• Communicate and follow up with external provider and/or vendor via telephone and/or email
• Provide clerical support to the Hospital Claims department including but not limited to handling of mail filing, typing, photocopying, faxing, deliveries, etc.
• Perform additional duties and special projects assigned by management

Skills

Data entry

Excellent communication

Organizational skills

Multi-tasking

Problem solving

Education

High School Diploma or GED

Tools

Microsoft Excel

Microsoft Word

Job description

1199SEIU is seeking a detail‑oriented clerical professional to support the Hospital Claims Department. You will maintain accurate data for member information in the QNXT system and ensure timely processing of inquiries for adjustments through DMS.

The role involves scanning and archiving documents, handling reconsideration letters, and coordinating with internal departments and external providers. Strong data entry and communication skills are essential.