Hospital Claims Processor V

1199SEIU Benefit and Pension Funds; New York (NY); On-site; USD 45,000 - 60,000; Full time

Job summary

1199SEIU Benefit and Pension Funds in New York is hiring for a position focused on reviewing and processing hospital claims within a health insurance environment. The ideal candidate will have a minimum of two years of experience and strong knowledge of eligibility and benefits.

This role requires attention to detail, the ability to handle multiple tasks, and a strong understanding of claims regulations and coding. Join a reputable organization dedicated to providing excellent health benefits.

Qualifications

• Minimum two years experience entering and updating hospital or medical claims.
• Ability to meet strict deadlines and work well under pressure.
• Work well independently and in a team environment.

Responsibilities

• Review hospital claims and determine action needed.
• Process and evaluate hospital claims manually or through a claims workflow.
• Finalize hospital claims by applying knowledge of eligibility and operational procedures.

Skills

Knowledge of hospital claims

Organizational skills

Multitasking

Analytical skills

Basic keyboarding skills

Knowledge of ICD-9, ICD-10, CPT codes

Education

High School Diploma or GED

Some college or degree preferred

Tools

Health claims system (QNXT)

Job description

Responsibilities

• Review hospital claims and determine action needed to resolve pended claims
• Process and evaluate hospital claims manually or through a claims workflow
• Validate information entered in the hospital claims module (QNXT) and determine the workflow needed to resolve discrepancies
• Finalize hospital claims by applying knowledge of eligibility, benefits, pre‑authorization rules, contractual policy and operational procedures
• Review, finalize and respond to call‑tracking tickets in a timely manner to provider inquiries
• Perform additional duties and special projects as assigned by management

Qualifications

• High School Diploma or GED required; some college or degree preferred
• Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment
• Basic keyboarding skills required
• Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT)
• Good knowledge of International Classification of Diseases (ICD‑9, ICD‑10) and Current Procedural Terminology (CPT) codes
• Demonstrated organizational, multitasking, and analytical skills with the ability to follow through on assignments
• Able to work well independently and in a team environment
• Ability to meet strict deadlines, work well under pressure and in a fast‑paced environment
• Must meet performance standards including attendance and punctuality