Claims Specialist

ISLAND PEER REVIEW ORGANIZATION INC; New York (NY); On-site; USD 66,000 - 70,000; Full time

Job summary

IPRO, headquartered in Jericho, NY, seeks a Claims Specialist to coordinate clinical review projects and support interagency communications. You will monitor requests, liaise with clinical partners, and manage provider and contractor interactions while tracking deliverables and deadlines.

Responsibilities include processing cases, identifying process improvements, presenting status in huddles, and coordinating invoicing with Finance.

Qualifications

• Bachelor's or advanced degree in healthcare, business, management or related field.
• 2 years of collaborative project support.
• Experience coordinating clinical review processes is preferred.

Responsibilities

• Monitor appeal/dispute status and communications on client portals.
• Conduct initial eligibility reviews and advise internal team.
• Track and assign cases using commercial off-the-shelf and custom software.
• Monitor and measure key performance indicators.
• Identify barriers, propose solutions, and implement approved changes.
• Present case status in huddles and scrums with an agile approach.
• Schedule team meetings and record decisions and next steps.
• Prepare billing invoices and liaise with Finance to track payments.

Skills

Collaboration

Project management

Written communication

Verbal communication

Time management

Independent worker

Education

Bachelor's degree or higher

Associate degree

Tools

Project management software

Job description

Job Description

Job Description

Claims Specialist

As the Claims Specialist, you will coordinate activities critical to the successful completion of clinical reviews projects. You will support programs by monitoring requests, liaising with clinical partners, managing provider and contractor interactions, tracking deliverables and deadlines, and develop project frameworks to support interdisciplinary and interagency communications. Duties include by are not limited to:

• Monitor appeal/dispute status and communication received on client portals.
• Conduct initial eligibility reviews and recommend course of action to internal team and department management.
• Track and assign cases using commercial off-the-shelf and custom software applications.
• Monitor and measure key performance indicators.
• Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions.
• Routinely present case/project status in huddles and scrums while using an agile, iterative approach to implementation and data presentation.
• Schedule regular team status meetings and record decisions (e.g., assigned tasks and next steps).
• Prepare billing invoices at conclusion of cases, submit to the Finance department, and liaise with accounting to track and trend payments.

This is an in office position based in IPRO's headquarter office located in Jericho, NY

QUALIFICATIONS:

• Knowledge and experience with collaborative project management software, electronic documents, and design.
• Ability to problem solve and work collaboratively with peers, medical, analytical, and administrative support staff.
• Excellent written and verbal skills including phone manner.
• Ability to work independently with little supervision.
• Ability and desire to be flexible, innovative, and creative while multi-tasking.
• Ability to meet deadlines in time sensitive environment.

EDUCATION & EXPERIENCE:

• Bachelors or advanced degree in healthcare, business, management digital studies or related field AND 2 years of collaborative project support, required.

- OR-

• Associates degree in related field AND 3 years of collaborative project support, required.

The salary range listed is a good faith determination of potential base compensation that may be offered to a successful applicant for this position at the time of this job advertisement and may be modified in the future. The salary range for this position is $66,300.00 to $70,000.00 . Actual salary and/or hourly rate depends on a variety of factors including experience, education, credentials, location, and budget.

The salary range listed does not include other forms of compensation or benefits.

IPRO is an Equal Opportunity Employer. All qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, age, disability, protected veteran status or military status.