Healthcare Claims Payments Specialist

IPRO; Jericho (NY); Hybrid; USD 66,000 - 70,000; Full time

Job summary

IPRO in Jericho, NY is seeking a full-time Claims Payment Specialist to manage payment reconciliation, tracking, and refund administration for Federal Independent Dispute Resolution operations. You will work with stakeholders and internal teams to ensure accurate payment processing, dispute resolution, reporting, and compliance with financial controls.

The role requires strong Excel, attention to detail, and experience with financial systems.

Qualifications

• Experience researching payment discrepancies, reconciling transactions, and maintaining financial records.
• Advanced Microsoft Excel skills, including formulas, pivot tables, sorting, filtering, and data validation.
• Experience using financial systems, databases, case management platforms, or CRM tools such as Salesforce.
• Strong attention to detail and accuracy in a high-volume environment.
• Excellent organizational and time-management skills with the ability to manage competing priorities.

Responsibilities

• Review daily bank activity and identify incoming payments and deposits.
• Match remittance information to payments and maintain accurate records.
• Determine the source of payments, including providers, health plans, and other entities.
• Link payments to the appropriate disputes and transaction records.
• Research payments received without remittance documentation and identify related disputes.
• Maintain complete documentation and audit trails for payment activity, updates, adjustments, and account records.
• Respond to payment inquiries, remittance requests, and refund requests from providers, health plans, and other stakeholders.
• Partner with Accounting to support payment processing, reconciliation, and reporting.
• Prepare and distribute daily transaction reports.
• Monitor payment activity, outstanding items, workload, and operational metrics using system reports and tracking tools.
• Research and resolve unmatched transactions and payment discrepancies.
• Review disputes for closure when payment has not been received and document outcomes appropriately.
• Prepare and maintain bi-monthly closed-dispute reports, including data validation and cleanup.
• Maintain payor refund addresses and payment information.
• Support the setup of new ACH vendors.
• Review payment activity to determine refund eligibility, amounts, and recipients.
• Prepare refund requests and supporting documentation for approval and processing.
• Maintain records of issued checks, EFTs, remittances, and related financial documentation.
• Respond to inquiries regarding payment requirements, payment status, and refund processing.
• Meet internal deadlines and CMS requirements.
• Support audits, process improvements, reconciliation projects, and other special assignments.

Skills

Payment reconciliation

Excel advanced

Financial systems

Data analysis

Attention to detail

Cross-functional teamwork

Communication skills

Education

Bachelor's degree in Business/Finance/Accounting

Associate degree in related field

Tools

Salesforce

Job description

IPRO in Jericho, NY is seeking a full-time Claims Payment Specialist to manage payment reconciliation, tracking, and refund administration for Federal Independent Dispute Resolution operations. You will work with stakeholders and internal teams to ensure accurate payment processing, dispute resolution, reporting, and compliance with financial controls.

The role requires strong Excel, attention to detail, and experience with financial systems.