Claims Service Correspondent

MetroPlusHealth; New York (NY); Hybrid; USD 55,000 - 65,000; Full time

Job summary

MetroPlusHealth in New York is seeking a Claims Service Correspondent to respond to written provider inquiries and support adjudication across multiple lines of business.

The role partners with Provider Contracting, Medical Management, Enrollment and Membership, and Claims Processing to ensure accurate resolutions and timely follow-up. A high school diploma and 2 years of claims experience are required.

Qualifications

• High School Diploma required.
• Minimum 2 years of experience in claims processing protocols and payment schemes.
• Proficiency working in a comparable Claims Processing Database.
• Thorough knowledge of health benefits plans.
• Must be able to resolve concerns with providers in a professional manner.

Responsibilities

• Act as a key liaison and service representative for all written provider inquiries and problem resolution.
• Respond to all claim inquiries from provider sites including physicians, clinical staff, and site administrators.
• Coordinate and track appropriate problem resolution activities with plan personnel in other departments (e.g., Claims, Utilization Management).
• Manage and ensure appropriate follow-up and closure for all inquiries.
• Respond to providers’ inquiries in writing and maintain accurate tracking.
• Data entry into the Claims Processing and Correspondence Distribution systems.
• Perform claim adjustments to correct erroneous payments (overpayments/underpayments).
• Perform claim adjustments due to Authorization Appeals and Retro Reviews.
• Participate in special projects involving Claim Status Investigations.
• Resolve Member Bills referred from Member Services.

Skills

Provider inquiries handling

Health benefits knowledge

Professional communication

Claims processing systems

Integrity and trust

Customer service focus

Written/Oral communication

Functional/Technical skills

Education

High School Diploma

Tools

Claims Processing Database

Job description

Claims Service Correspondent

Job Ref: TE0167
Category: Claims
Department: CLAIMS
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $55,000.00 - $64,518.00

Position Overview

The Claims Service Correspondent is responsible for accurate and timely responses to written claim inquiries received from providers. This individual provides support regarding the adjudication and adjustment of claims for multiple lines of business. They will work closely with Provider Contracting, Medical Management, Enrollment and Membership department, and Claims Processing unit.

Scope of Role & Responsibilities

• Act as a key liaison and service representatives for all written provider inquiries and problem resolution.
• Respond to all claim inquiries from provider sites including physicians, clinical staff, and site administrators.
• Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., Claims, Utilization Management, etc.)
• Manage and ensure appropriate follow-up and closure for all inquiries.
• Respond to providers’ inquiries in writing and maintain accurate tracking.
• Data entry into the Claims Processing and Correspondence Distribution systems.
• Perform claim adjustments to correct erroneous payments (overpayments/underpayments).
• Perform claim adjustments due to Authorization Appeals and Retro Reviews.
• Participate in special projects involving Claim Status Investigations.
• Resolve Member Bills referred from Member Services.

Required Education, Training & Professional Experience

• High School Diploma required.
• Minimum 2 years of experience in claims processing protocols and payment schemes.
• Proficiency working in a comparable Claims Processing Database.
• Thorough knowledge of health benefits plans.
• Must be able to resolve concerns with providers in a professional manner.

Professional Competencies

• Integrity and Trust
• Customer Service Focus
• Functional/Technical skills
• Written/Oral Communication

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