New York Licensed Medical Claims Specialist

Job Summary

A company is looking for a Medical Claims Resolution Specialist.

Key Responsibilities

• Contact healthcare providers to negotiate discounts on eligible claims prior to payment
• Perform provider research and address counteroffers to achieve resolution while adhering to client guidelines
• Maintain departmental performance metrics and handle post-claim service inquiries

Required Qualifications, Training, and Education

• Minimum high school diploma or GED
• At least 6 months of experience in the healthcare industry; 1 year preferred
• State licensure certification may be required and must be obtained within six months if not already held
• Knowledge of general office operations and standard medical insurance claim forms
• Ability to work independently and handle confidential information