Claims Support Specialist

Nascentia Health, Inc.; City of Syracuse (NY); Hybrid; USD 27,000 - 34,000; Full time

Benefits offered by this job

401K with generous Employer match

On-Site Gym (free for all employees)

Tuition Reimbursement

Partially funded HSA

Employee Recognition Platform

Paid Time Off, Holidays, Sick and Ext.

Short/Long term Disability

Employee Assistance Program (EAP)

Much More!

Job summary

Nascentia Health is seeking a Claims Support Specialist to assist health plan members, providers, and adjudicators with benefits application and claims payments. The role is full-time, Mon-Fri, 8a-4:30p, based in the Syracuse Office.

You will work with the TPA to resolve issues, respond to inquiries, and ensure compliant, timely processing of Medicaid and Medicare claims, while maintaining HIPAA privacy and delivering excellent service.

Qualifications

• High School Diploma or equivalent required.
• Prioritizing, problem-solving, multi-tasking and meeting deadlines.
• Insurance experience; Medicare benefits knowledge is a plus.
• Excellent verbal and written communication.
• Discretion with confidential and sensitive information.

Responsibilities

• Resolve authorization, contract and eligibility issues with the TPA.
• Respond to and record inquiries from members, providers and others about coverage and claims payments.
• Collaborate with departments and vendors to ensure claims are processed per policies.
• Conduct regular review of claims based on plan needs.
• Document and communicate issues related to claims adjudication to supervisor.
• Provide guidance on billing and payments per agency policies.
• Participate in CQI activities and continuous improvement.
• Adhere to HIPAA and privacy requirements at all times.
• Provide courteous, responsive customer service.
• Perform other duties as assigned.

Skills

Prioritization

Problem-solving

Multi-tasking

Meeting deadlines

Excellent communication

Insurance experience

Medicare knowledge a plus

Education

High School Diploma or equivalent

Job description

Proudly ranked #14 Best Company to Work for in New York in 2025

Find a Career With Meaning

At Nascentia Health, we deliver care and support at home and in the community, creating a different experience than a traditional hospital setting. You’ll find more one-on-one focus, stronger connections, and work you can feel proud of.

Browse our current openings below and apply.

The Claims Support Specialist provides support to the health plan members, providers and third party adjudicator to ensure understanding of the application of benefits and accuracy, timeliness and appropriateness of claims payments. This position is full-time, Mon-Fri, 8a-4:30p, reporting to our Syracuse Office.

Performance Responsibilities and Standards:

• Works directly with TPA to resolve authorization, contract and eligibility issues.
• Receives, responds to and/or records inquiries from members, providers, and other consumers related to areas of coverage and payment of claims for Medicaid and Medicare plans.
• Collaborates with other health plan departments and vendors to ensure claims are processed in accordance with agency established guidelines and/or policies and procedures.
• Conducts regular review of claims based on plan needs.
• Documents and communicates issues related to claims adjudication to supervisor in a timely manner.
• Provides assistance and guidance consistent with agency policies and procedures to members and providers related to billing and payments.
• Actively participates in performance improvement and continuous quality improvement (CQI) activities.
• Ensures adherence at all times to all applicable department and professional standards, to include HIPAA and Privacy requirements.
• Provides courteous, responsive, respectful and knowledgeable customer service.
• Performs other duties as assigned.

Requirements:

• High School Diploma or equivalent required.
• Skilled in prioritizing, problem-solving, multi-tasking, and meeting deadlines.
• Insurance experience. Understanding of Medicare benefits a plus.
• Demonstrates discretion in handling confidential and sensitive information
• Excellent communication skills, verbal and written.

Physical Requirements:

• Speaking/visual/hearing ability sufficient to comprehend and express written/verbal communication.
• Extended periods of computer use.
• Ability to sit or stand at a desk 90% of the day
• Bloodborne Pathogens Exposure Category III – Employee who rarely has contact with blood and body fluids.

Physical Requirements:

• Ability to sit or stand at a desk 90% of the day. Frequent sitting, standing, walking.
• Visual/hearing ability sufficient to comprehend written or verbal communication.
• Ability to express oneself verbally and in writing.
• Must be able to engage in real-time phone communication with clients, caregivers, and providers as a core job function.
• Extended periods of computer use.
• Ability to lift and move objects up to 40 pounds.
• Bloodborne Pathogens Exposure Category III - Employee who rarely has contact with blood and body fluids

Competitive Salary [This position is an H06 non-exempt position with a min-max rate of: $19.96-$24.96/hour] with:

• 401K with generous Employer match
• On-Site Gym (free for all employees)
• Tuition Reimbursement
• Partially funded HSA
• Employee Recognition Platform
• Paid Time Off, Holidays, Sick and Extended Sick Leave
• Short/Long term Disability
• Employee Assistance Program (EAP)
• Much More!

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About Nascentia Health:

Nascentia Health is leading the way in home care, post acute care and long-term community health. A healthcare system without walls, Nascentia is an innovator in the concept of healthcare, truly focused on the patient as a whole. By serving people in their homes, Nascentia Health is able to provide true holistic care. We can address immediate needs, help support positive long term medical and lifestyle choices that provide for better outcomes, leverage cutting edge in-home care technologies, and help avoid unnecessary visits to busy healthcare facilities.

Our employees are our greatest asset. They work hard every day to make our system amazing and are dedicated to our mission of being the premier home and community-based care system for the regions we serve. We want everyone to love what they do, be excited about coming to work, and take pride in being part of our team.

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Nascentia Health is an Equal Opportunity Employer (EOE)

Employment is contingent upon negative results of a pre-hire drug screen and background check clearance.