Health Claims Operations Specialist - Impact & Quality

Building Service 32BJ Benefit Funds

New York (NY)

On-site

USD 73,000 - 78,000

Full time

14 days+

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Job summary

Building Service 32BJ Benefit Funds in New York, NY is seeking a Health Operations Claims Specialist to deliver high-quality customer service and expert claims support for 180,000+ plan participants. The role focuses on accurate and timely claims processing, collaboration with providers, vendors, and internal teams, and ensuring compliance with plan rules.

The position requires thorough knowledge of benefits, claims processing policies, and strong communication and analytical abilities to

Qualifications

2+ years of work experience in health insurance claims or claims operations.
Knowledge of claim processing policies and ICD-10/CPT coding basics.
Excellent verbal and written communication, analytical, and problem-solving skills.

Responsibilities

Maintain deep expertise of the Fund's covered benefits and claim rules.
Evaluate claims for eligibility, provider contracting, and plan design.
Research third-party policies and medical management guidance for claims.
Collaborate with the third-party administrator on processing issues.
Conduct member outreach to resolve claims inquiries and issues.
Identify trends, perform root-cause analysis, and document findings for leadership.
Use the Funds' database to verify eligibility, benefits, and communications.