Job Ref: TE0167
Category: Claims
Department: CLAIMS
Location: 50 Water Street, 7th Floor,
New York,
NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $55,000.00 - $64,518.00
Position Overview
The Claims Service Correspondent is responsible for accurate and timely responses to written claim inquiries received from providers. This individual provides support regarding the adjudication and adjustment of claims for multiple lines of business. They will work closely with Provider Contracting, Medical Management, Enrollment and Membership department, and Claims Processing unit.
Scope of Role & Responsibilities
Act as a key liaison and service representatives for all written provider inquiries and problem resolution.
Respond to all claim inquiries from provider sites including physicians, clinical staff, and site administrators.
Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., Claims, Utilization Management, etc.)
Manage and ensure appropriate follow-up and closure for all inquiries.
Respond to providers’ inquiries in writing and maintain accurate tracking.
Data entry into the Claims Processing and Correspondence Distribution systems.
Perform claim adjustments to correct erroneous payments (overpayments/underpayments).
Perform claim adjustments due to Authorization Appeals and Retro Reviews.
Participate in special projects involving Claim Status Investigations.
Resolve Member Bills referred from Member Services.
Required Education, Training & Professional Experience
High School Diploma required.
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.
Must be able to resolve concerns with providers in a professional manner.
Professional Competencies
Integrity and Trust
Customer Service Focus
Functional/Technical skills
Written/Oral Communication
#LI-Hybrid
#MHP50
...way toward inspired learning. When you join our team as a Teacher you will: Lead, coach and mentor less experienced teachers in... ...status, gender identity or expression, or any other basis protected by local, state, or federal law. Job Posting End Date : 2026-12-31
...Job Title: Key Account Executive (Sporting Goods) Location: Home based in the Pittsburgh, PA area Industry: Sporting Goods Market... ...Executive to own its largest and most strategic retail relationship, Dicks Sporting Goods. Based in Pittsburgh, Pennsylvania, and...
OM MANUFACTURING LLC is looking for a full-time Recruiter to manage the recruitment process for construction positions. You will be responsible for sourcing candidates, managing pipelines, and coordinating interviews to ensure teams are fully staffed.With 2+ years of experience...
...Responsible for set up, operating, adjusting, testing and maintaining extruder and header equipment. Maintains quality check log and completes production report on a daily basis. Communicates quality, material and production issues to supervisor. Keeps area clean...
Residential Mortgage Inspector Opportunity FAR Inspections is actively seeking a reliable independent contractor to perform residential mortgage inspections in Chilton County, Alabama and surrounding communities. If you live in or near Calera or anywhere in Chilton ...