Job Ref: TE0175
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: $50,000.00 - $54,194.00
Position Overview
The Claims Examiner I is responsible for the data entry and system adjudication of provider claims. The incumbent authorizes final disposition of claims within prescribed guidelines in an accurate and timely manner.
Scope of Role & Responsibilities:
Process claims involving medical and/or surgical services; screens for complete member/provider information
Apply administrative policies when necessary, utilizing the claims processing manuals
Authorizes the generation of letters/questionnaires to providers to obtain additional information
Reviews descriptions of services on claims to determine validity of charges of the presence of errors
Evaluates and examines claims pended by the system due to contractual and/or payment discrepancies
Maintains production and quality goals established for the department
Performs other related duties, i.e., maintaining individual production counts, updating manuals and reference materials, attending all refresher training seminars
Required Education, Training & Professional Experience
Associate’s Degree required; and
Minimum 2 years’ experience in the healthcare insurance industry with knowledge of integrated claims processing; or
A satisfactory equivalent combination of education, training, and experience
Proficiency with data entry skills
Through knowledge of medical terminology, CPT, ICD-p, and Revenue Codes
Professional Competencies
Integrity and Trust
Customer Focus
Functional/Technical skills
Written/Oral Communication
#LI-Hybrid
#MHP50
Junior Python / Data Engineer Job Type: Contract Location: Toronto, ON Hybrid Duration: 3 Months, Possible Extension Role Summary We are seeking a Junior Software / Data Engineer with 1 3 years of experience in software development, data engineering...
...without! No private insurance needed! Just bring a great attitude! NEW HOURLY RATES + TIPS! Smart routes so you make more! NOW HIRING IMMEDIATELY Earn $14 - $22 an hour as a Papa Johns Pizza delivery driver Full time or part time Day shift, night shift,...
...Job Description Medical Courier Delivery Drivers Medical Courier Delivery Drivers needed to deliver time-sensitive medical supplies across the region. ~$1.30 per mile round trip/$30 minimum ~ Vehicle Type: Cars, SUV ~ OnDemand ~ Contract Tools: Cooler/Insolated...
Hybrid role in Middleton, WIJob TitleGrowth Product Manager Job #US20157 Requisition TypeRegular Function Product Development State/ProvinceWisconsin CityMiddleton Region US Posting Start DateAug-26-2026...
...Engineer (F/T & Remote)- Company: Solid fast-growing award winning Cisco Gold Partner - Location: Remote from anywhere Mid Atlantic to... ...Data Center arena. keywords: cisco sales engineer ccnp ccna ccie route switch, troubleshooting wireless ehahau meraki nexus...