Provider Claims Resolution Specialist

MetroPlus; New York (NY); On-site; USD 45,000 - 65,000; Full time

Job summary

MetroPlus in New York is looking for a Claims Service Correspondent responsible for providing accurate responses to claim inquiries from healthcare providers. This role involves coordination with multiple departments and resolving issues professionally.

Qualifications include a High School Diploma and at least two years of experience in claims processing. Candidates should have strong customer service skills and proficiency in relevant claims databases.

Qualifications

• Minimum 2 years of experience in claims processing protocols and payment schemes.
• Proficiency working in a comparable Claims Processing Database.
• Thorough knowledge of health benefits plans.

Responsibilities

• Act as a key liaison for all written provider inquiries.
• Respond to all claim inquiries from provider sites.
• Manage and ensure follow-up for all inquiries.
• Perform claim adjustments to correct erroneous payments.

Skills

Integrity and Trust

Customer Service Focus

Functional/Technical skills

Written/Oral Communication

Education

High School Diploma

Tools

Claims Processing Database

Job description

MetroPlus in New York is looking for a Claims Service Correspondent responsible for providing accurate responses to claim inquiries from healthcare providers. This role involves coordination with multiple departments and resolving issues professionally.

Qualifications include a High School Diploma and at least two years of experience in claims processing. Candidates should have strong customer service skills and proficiency in relevant claims databases.