Claims Specialist Salary at Medtrx BETA

A health services network in New York is currently seeking a new Claims Specialist for a promising opportunity with their growing team in Flushing. Responsibilities: The Claims Specialist will: Be responsible for reviewing claims processed by the outside vendor, including resolving provider appeals/disputes. Performs root cause analysis for all provider projects to identify areas for provider education and/or system (re)configuration. Initiates and follows through with resolution of all pended claims. Reviews and investigates claims to be adjudicated by the TPA, including the application of contractual provisions in accordance with provider contracts and authorizations Compiles claim reports for adjustments resulting from external providers, vendors, and internal inquiries in a timely manner Investigates suspense conditions to determine if the system or procedural changes would enhance claim workflow Communicates and follows up with a variety of internal and external sources, including

Job Description Job Description Claims Specialist Our client is a national organization providing a full spectrum of healthcare assessment and improvement services that foster more efficient use of resources and enhance healthcare quality. For more than 30 years they have been highly regarded and have had contracts with federal, state, and local government agencies, as well as private-sector clients. The company works nationally and has offices in 7 locations with headquarters in the NYC Metro area. They are currently seeking Claims Specialists who are responsible for effectively managing and resolving complex medical claims disputes. This role requires a strong understanding of healthcare regulations, excellent communication and interpersonal skills, and the ability to work independently and collaboratively within a fast-paced environment. This is an opportunity to gain valuable experience working at a well-respected healthcare organization. There is potential to transition to a perma

Job Description Job Description Claims Specialist (Temporary Opportunities) - $3,000 Sign-On Bonus As the Temp Claims Specialist, you will coordinate activities critical to the successful completion of clinical reviews projects. You will support programs by monitoring requests, liaising with clinical partners, managing provider and contractor interactions, tracking deliverables and deadlines, and develop project frameworks to support interdisciplinary and interagency communications. Duties include by are not limited to: Monitor appeal/dispute status and communication received on client portals. Conduct initial eligibility reviews and recommend course of action to internal team and department management. Track and assign cases using commercial off-the-shelf and custom software applications. Monitor and measure key performance indicators. Identify barriers and roadblocks in work processes, recommend solutions to solve problems, and execute approved solutions. Routinely present case/proje

This is your opportunity to join AXIS Capital a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry. At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family o

Our Company PharMerica Overview Join our PharMerica team! PharMerica is aclosed-door pharmacywhere you can focus on fulfilling the pharmaceutical needs of our long-term care and senior living clients. We offer a non-retail pharmacyenvironment. Our organization is inhigh growth mode, which meansadvancement opportunitiesfor individuals who are looking for career progression! This is an excellent opportunity to move from a retail to office environment for those who are willing to learn claims, billing and insurance processing. Pharmacy Technician experience and/or knowledge of pharmaceuticals is a strong preference. We offer: DailyPay Flexible schedules Competitive pay Shift differential Health, dental, vision and life insurance benefits Company paid STD and LTD Tuition Assistance Employee Discount Program 401k Paid-time off Tuition reimbursement Non-retail/Closed-door environment Our Pharmacy group focuses on providing exceptional customer service and meeting the pharmacy needs for hospi

Job Description Job Description The Claims Resolution Specialist plays a critical role in the successful adjudication of claims and appeals within our organization. This position requires a highly organized and detail-oriented individual with strong communication and problem-solving skills. The Specialist will collaborate with internal and external stakeholders to ensure timely and accurate resolution of claims, while adhering to all relevant regulations and guidelines. Responsibilities: Act as the primary point of contact for all aspects of claim appeals and disputes. Conduct thorough initial eligibility reviews and recommend appropriate courses of action. Liaise effectively with healthcare plans, providers, patients, and clients to gather necessary information and facilitate claim resolution. Monitor claim status, track key performance indicators (KPIs), and identify potential areas for improvement. Analyze claim data to identify trends and patterns, and develop strategies to mitigat

This is your opportunity to join AXIS Capital a trusted global provider of specialty lines insurance and reinsurance. We stand apart for our outstanding client service, intelligent risk taking and superior risk adjusted returns for our shareholders. We also proudly maintain an entrepreneurial, disciplined and ethical corporate culture. As a member of AXIS, you join a team that is among the best in the industry. At AXIS, we believe that we are only as strong as our people. We strive to create an inclusive and welcoming culture where employees of all backgrounds and from all walks of life feel comfortable and empowered to be themselves. This means that we bring our whole selves to work. All qualified applicants will receive consideration for employment without regard to race, color, religion or creed, sex, pregnancy, sexual orientation, gender identity or expression, national origin or ancestry, citizenship, physical or mental disability, age, marital status, civil union status, family o

Job Description Job Description The Claim Specialist is responsible for processing, reviewing, and resolving healthcare claims in accordance with company policies, industry regulations, and compliance standards. This role ensures timely and accurate claims adjudication while providing excellent customer service to internal and external stakeholders. Key Responsibilities: Review and process healthcare claims for accuracy, completeness, and compliance with company policies and industry standards. Investigate claim discrepancies, denials, and appeals, ensuring proper resolution within established guidelines. Communicate with healthcare providers, policyholders, and internal teams to resolve claim-related inquiries and discrepancies. Maintain detailed and accurate records of claims processing activities and outcomes. Ensure claims adjudication adheres to regulatory requirements, including HIPAA and other healthcare compliance standards. Assist in identifying trends and potential fraud or a