Claims Processor - Healthcare / Medical

For the last 80 years, EmblemHealth has been taking care of New York’s heart and soul, its people. Today, health care is more complex than ever. We work alongside our customers to offer access to high-quality, affordable care, help navigate the health care experience, and make good health achievable; We believe a culture of diversity and inclusion is vital to serve our unique and diverse customers. We seek for continuous improvement and innovation and believe being agile and nimble is our advantage. We bring a strong sense of partnership to every relationship - internally and externally. The EmblemHealth family of companies offers competitive health, welfare, and retirement benefits as well as incentive pay plans and more. Support contract performance management of a large health system. Review and analyze suspected underpaid and overpaid claims from hospital, ancillary, and provider groups based on contractual and industry guidelines. Evaluate disputed claims for system configuration, claims processing, and/or contractual issues to facilitate claims review. Maintain and organize detailed information on claims dispute files to ensure appropriate and comprehensive data is returned to the provider timely. Identify potential/actual claims problems (single or recurring/trending) and document root cause analysis; Improve quality, enhance workflow, and provide efficiencies within departments, identify opportunities for improvements; Support departmental goals for cycle time by organizing and tracking claims for review. Qualifications: Bachelor’s Degree 2 - 3 years’ prior related work experience in professional/facility claims or benefits/billing environment (Required) Additional experience/specialized training may be considered in lieu of educational requirements (Required) Strong knowledge of claim processing policies and procedures (Required) Knowledge of medical terminology, ICD/CPT coding, per diem and DRG reimbursement and EDP testing procedures (Required) Proficiency with MS Office applications (word processing, database/spreadsheet, presentation) (Required) Ability to effectively work on multiple projects/tasks with competing priority levels and deadlines (Required) Security Disclosure If you are offered a job from one of the EmblemHealth family of companies that includes ConnectiCare, AdvantageCare Physicians, and WellSpark, the offer confirmation email will come from “HRTalentAcquisition” with the subject line: “Offer of Employment for (job title)” - Please respond online. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilities of the position, the candidate’s work experience, education/training, internal peer equity, and market and business considerations. Union roles covered by a collective bargaining agreement will compensate in accordance with the union contract. We are an equal opportunity/affirmative action employer, and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex/gender, sexual orientation, gender identity or expression, pregnancy or related condition, marital status, national origin, disability, protected veteran status or any other characteristic protected by law. Sponsorship Statement Depending on factors such as business unit requirements, the nature of the position, cost and applicable laws and regulations, EmblemHealth may provide work visa sponsorship for certain positions. # Apply tot his job