Claims Specialist

Position: Claims Adjustment Specialist I

Location: New York, NY 10004

Job Type: Contract

Contract: 8 weeks (with potential extension)

Schedule: MondayFriday | 9:00 AM 5:00 PM (Hybrid)

Guaranteed hours per week: 35.00

Pay: Up to $30/hour

Job Summary

Pride Health is seeking an experienced Claims Adjustment Specialist I for a contract opportunity in New York, NY. This role is responsible for reviewing, analyzing, and adjusting medical claims to ensure accurate payment processing in compliance with healthcare guidelines and policies.

Responsibilities

Research and analyze medical claims adjustment requests and supporting documentation

Adjust and adjudicate claims for overpayments or underpayments

Apply appropriate payment guidelines including CMS, Medicare, Medicaid, and plan benefits

Identify claim discrepancies related to coding, reimbursement rates, or authorizations

Communicate findings and resolutions to internal teams and external providers

Respond to provider inquiries regarding claims processing and payment issues

Maintain accurate documentation and records of all claims processed

Generate reports on claim activity and assist with audits

Ensure timely processing of claim adjustments according to established timelines

Stay updated with changes in claims processing guidelines and coding standards

Utilize multiple systems including CRM tools (Salesforce preferred) and claims platforms

Requirements

Minimum 3 years of experience in healthcare claims operations

Strong knowledge of medical claims processing and adjudication

Familiarity with CPT, ICD-10, and Revenue Codes

Experience with claims systems and CRM tools (Salesforce preferred)

Strong analytical, problem-solving, and decision-making skills

Proficiency in Microsoft Excel and Word

Excellent communication and documentation skills

Preferred Qualifications

Associate degree preferred (High School Diploma/GED required)

Experience with HCFA and UB-04 claim forms

Knowledge of HIPAA regulations and compliance

Experience handling provider inquiries and claim investigations

Ability to work independently and manage multiple priorities

Why Work with Pride Health?

Pride Health offers eligible employees comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance, and hospital indemnity), 401(k) retirement savings, life & disability insurance, an employee assistance program, legal support, auto and home insurance, pet insurance, and employee discounts with preferred vendors.