New York Licensed Medical Claims Specialist

Job Summary

A company is looking for a Medical Claims Resolution Specialist II, Appeals.

Key Responsibilities

• Negotiate health care claims with providers to achieve maximum discounts and savings
• Perform claim research and manage a high volume of healthcare claims while adhering to client guidelines
• Collaborate with internal and external clients to facilitate negotiations and maintain provider relationships

Required Qualifications

• Minimum high school diploma or GED
• At least 2 years of experience in a service-based industry, preferably in healthcare or medical insurance
• State licensure certification may be required and must be obtained within six months if hired without it
• Knowledge of medical coding systems and general office operations is desired
• Ability to work independently, handle confidential information, and use relevant software and hardware