Disability Claims Examiner jobs in Huntington, NY
Disability Claims Examiner reviews, evaluates and processes disability insurance claims according to procedure and practice. Examines claims material to ensure insurance coverage and validity. Being a Disability Claims Examiner has contact with agents, claimants, and policy holders. Typically requires a bachelor's degree or its equivalent. Additionally, Disability Claims Examiner typically reports to a supervisor/manager. To be a Disability Claims Examiner typically requires 0-2 years of related experience. Works on projects/matters of limited complexity in a support role. Work is closely managed. (Copyright 2024 Salary.com)
Recently Added Disability Claims Examiner jobs
Claims Examiner
- Centers Plan for Healthy Living
-
Farmingdale, NY
FULL_TIME
-
Centers Plan for Healthy Living's goal is to create the ultimate healthcare experience that provides our members, their families, healthcare decision makers, and general caregivers with the guidance and plans they need for healthy living.
Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with opportunities for cross-training and education, CPHL is the place for a fulfilling long-term career.
JOB SUMMARY:
Responsible for the timely and accurate adjudication of all claims for Centers Plan for Healthy Living (CPHL) products. Reviews and resolves pended and corrected claims. Analyzes claim resubmissions to determine areas for provider education or system re-configuration. Serve as the primary point of contact for claim issues raised by Providers and internal CPHL departments. Provides feedback on department workflows and identifies opportunities for redesign. Performs claims testing to ensure that systems are designed efficiently based on the Plan's benefit structure.
PRIMARY RESPONSIBILITIES:
- Review, research and finalize provider claims within established regulatory requirements and CPHL policies.
- Analyze provider issues and collaborate with other departments to resolve. Identifies and documents opportunities for provider education.
- Review provider disputes or appeals and provide a detailed analysis of findings.
- Conduct claim testing for CPHL products.
- Review claim processing results of Delegated Vendors
- Provides expertise and assistance relative to provider billing and payment guidelines consistent with CPHL policies and procedures and State or CMS guidelines.
- Document all provider contacts; including telephonically, emails, written correspondence
- Trouble shoot and identify root cause of problems and participate in developing solutions
- Provides follow up and intervention relating to provider claim inquiries
- Collaborate with internal teams and departments to ensure applications are processed, contracts are executed and all providers are credentialed in a timely manner.
- Participates in standing meetings as necessary, including but not limited to provider relations, contracting, network development, team building.
- Performs other duties and special projects as assigned and directed.
Education
Required: BA/BS degree in a financial field or equivalent healthcare experience
Preferred:
Type of Experience
Required: 3 years of claim processing experience, preferably in a Medicaid/Medicare, MLTC environment, Customer Service in health insurance product environment.
Preferred:
Specific Technical Skills
Required: Use of Microsoft Access or similar query tool. Proficiency with MS applications, including but not limited to Word, Excel, Outlook, Power Point, Project
Strong telephonic and customer service skills
Certifications/Licensure:
Required: n/a
Knowledge and Skills:
- Effective presentation skills
- Excellent verbal and written communication skills
- Must be able to participate in meetings with all levels of management within the organization
- Detail oriented, excellent follow up
- Ability to multi-task in a fast paced environment
- Must be service oriented, quick learner, team player
- Appreciation of cultural diversity and sensitivity toward target population
SCOPE INFORMATION
# Direct Reports: n/a
PHYSICAL REQUIREMENTS:
The physical requirements described here are representative of those that must be met by an employee to successfully perform the essential functions of this job. Reasonable accommodations may be made to enable individuals with disabilities to perform the essential functions.
The above statements are intended to describe the general nature and level of work performed by individuals assigned to the job classification. They should not be construed as an exhaustive list of all responsibilities, duties and skills required.
Centers Plan For Healthy Living is committed to leveraging the diverse backgrounds, perspectives and experiences of our workforce to create opportunities for our employees and our business. We are an equal opportunity employer and all qualified applicants will receive consideration for employment without regard to race, color, religion, sex, national origin, disability, protected veteran status or any other characteristic protected by law and will not be denied employment. - 17 Days Ago
Claims Examiner
- Centers Plan for Healthy Living/Centers Care Solutions
-
Farmingdale, NY
FULL_TIME
- Individualized professional and personal growth is a primary focus at CPHL. With various teams to match the unique strengths of each individual, tiered roles to support the advancement, and with oppor...
- 19 Days Ago
Cloud Channel Manager
- Disability Solutions
-
Melville, NY
FULL_TIME
- Position:Cloud Channel ManagerJob Description:The Cloud Channel Manager will be responsible for the day-to-day sales support and customer service activities for assigned accounts in the East territory...
- 1 Month Ago
1:1 Aide for a Preschooler with a disability
- Building Blocks Developmental Preschool
-
Commack, NY
PART_TIME
- Building Blocks Developmental Preschool has an immediate need to fill a 1:1 aide position for a preschooler with a disability. The position consists of providing individual support to a student within...
- 21 Days Ago
Part-Time Proctor - Disability Services Center (DSC)
- Farmingdale State College
-
Farmingdale, NY
PART_TIME
- This is a part-time 30-hour a week position reporting to the Director of Disability Services. The part time proctor is responsible for managing the testing environment and processes in the Disability ...
- 11 Days Ago
Claims Consultant - Multi-Line
- General Placement Service
-
Melville, NY
FULL_TIME
- We’re looking for an experienced, customer-focused claims professional with a passion for helping others!Successful candidate will maintain a high-level of service and act as the liaison between insur...
- 1 Month Ago
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0 Disability Claims Examiner jobs found in Huntington, NY area
Workers Compensation Claims Analyst
- World Insurance Associates Llc
-
Syosset, NY
- Summary World Insurance Associates is a unique insurance organization offering top products and services from major prov...
- 4/25/2024 12:00:00 AM
Intern, Legal
- Leviton Manufacturing
-
Melville, NY
- About Leviton At Leviton, we build what's next to light, power, and connect everyday spaces, from electrical to lighting...
- 4/24/2024 12:00:00 AM
Workers' Compensation Claims Examiner
- Suffolk County, NY
-
Hauppauge, NY
- An employee in this class performs difficult examining work in a Workers' Compensation claims unit. Responsibility is in...
- 4/24/2024 12:00:00 AM
Workers Compensation Claims Analyst
- World Insurance Associates LLC
-
Syosset, NY
- Summary World Insurance Associates is a unique insurance organization offering top products and services from major prov...
- 4/23/2024 12:00:00 AM
PROBATION OFFICER TRAINEE
- Nassau County, NY
-
Hempstead, NY
- Salary: See Position Description Location : Nassau County, NY Job Type: Open Competitive Job Number: 88-122 Department: ...
- 4/23/2024 12:00:00 AM
Manager-Compliance
- American Express
-
New York, NY
- **Description** **You Lead the Way. Weve Got Your Back.** With the right backing, people and businesses have the power t...
- 4/22/2024 12:00:00 AM
Transportation Security Officer
- Department Of Homeland Security
-
Islip, NY
- Summary Transportation Security Officers are responsible for providing security and protection of travelers across all t...
- 4/22/2024 12:00:00 AM
PROBATION ASSISTANT, BILINGUAL (SPANISH SPEAKING)
- Nassau County, NY
-
Hempstead, NY
- Salary: See Position Description Location : Nassau County, NY Job Type: Open Competitive Job Number: 87-833 Department: ...
- 4/21/2024 12:00:00 AM
About Huntington, New York
The Town of Huntington is one of ten towns in Suffolk County, New York, United States. Founded in 1653, it is located on the north shore of Long Island in northwestern Suffolk County, with Long Island Sound to its north and Nassau County adjacent to the west. Huntington is part of the New York metropolitan area. As of the United States 2010 Census, the town population was 203,264....
Source: Wikipedia (as of 04/11/2019). Read more from Wikipedia
Income Estimation for Disability Claims Examiner jobs
$56,993 to $70,763
Huntington, New York area prices
were up 1.5% from a year ago
were up 1.5% from a year ago