Eligibility & Claims Specialist — Member Services

Employee Benefit Funds; New York (NY); On-site; USD 53,000 - 65,000; Full time

Benefits offered by this job

Medical, Dental, Pharmacy and Vision

Paid Time Off (Vacation, Personal, 12+

Job summary

Health Center Inc. (also known as The New York Hotel Trades Council and Hotel Association of NYC, Inc Employee Benefit Funds) in Manhattan seeks an Eligibility Clerk to provide member/customer service in claims and eligibility, and to analyze outcomes for members and providers.

The role requires at least 1 year in eligibility/claims, strong communication, and the ability to work independently within defined workflows and deadlines. Bilingual skills (Spanish/Mandarin/Cantonese) are a plus.

Qualifications

• Minimum 1 year of eligibility, claims, and insurance experience.
• Minimum high school diploma or equivalent.
• Excellent interpersonal and customer service skills.
• Ability to work independently, handle routine inquiries and resolve issues with minimal supervision.
• Excellent organizational skills and attention to detail.
• Strong oral and written communication skills.
• Ability to work under pressure, meet deadlines and multitask.
• Spanish, Mandarin, or Cantonese speaking a plus

Responsibilities

• Provide member/customer service in the areas of claims and eligibility following departmental workflows and policies/procedures.
• Analyze and communicate outcomes (eligibility status, payment levels, denials) to members and providers.

Skills

Customer service

Interpersonal skills

Communication

Organizational skills

Attention to detail

Multitasking

Education

High school diploma

Job description

Health Center Inc. (also known as The New York Hotel Trades Council and Hotel Association of NYC, Inc Employee Benefit Funds) in Manhattan seeks an Eligibility Clerk to provide member/customer service in claims and eligibility, and to analyze outcomes for members and providers.

The role requires at least 1 year in eligibility/claims, strong communication, and the ability to work independently within defined workflows and deadlines. Bilingual skills (Spanish/Mandarin/Cantonese) are a plus.