Claims Service Specialist: First‑Call Resolution

Centers Plan for Healthy Living; New York (NY); On-site; USD 52,000 - 60,000; Full time

Job summary

Cent ers Plan for Healthy Living (CPHL) is seeking an experienced provider relations/phone support specialist in New York. You will handle inquiries from physicians, clinics, and day cares regarding claim decisions and payments, educate callers on submission procedures, and work toward resolution on the first call.

You will document interactions, maintain logs, and contribute to process improvements while upholding CPHL policies and regulatory knowledge.

Qualifications

• HS Diploma required; 2 years of college preferred.
• Experience handling provider inquiries via phone, email or fax.
• Strong communication and problem‑solving abilities.

Responsibilities

• Handle inquiries from providers about claims and payments across CPHL products.
• Gather claim information, educate callers on submission procedures and resolve issues.
• Aim for first-call resolution and document call details and outcomes.
• Support quality and efficiency goals and maintain up‑to‑date product knowledge.

Skills

Customer service

Call handling

Provider relations

Communication skills

Education

HS Diploma

2 years of college preferred

Job description

Cent ers Plan for Healthy Living (CPHL) is seeking an experienced provider relations/phone support specialist in New York. You will handle inquiries from physicians, clinics, and day cares regarding claim decisions and payments, educate callers on submission procedures, and work toward resolution on the first call.

You will document interactions, maintain logs, and contribute to process improvements while upholding CPHL policies and regulatory knowledge.