Claims Examiner II

Claims Examiner II

Job Ref: TE0165
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: $54,000.00 - $64,474.00

Position Overview

The ideal candidate will have experience processing healthcare claims in a high-volume Claims Department. Must be computer literate and have ability to enter data into computer system with speed and accuracy. Must be able to demonstrate time management and strong organizational skills.

Scope of Role & Responsibilities

Process all claims identified as exceeding claim age parameters established within the unit (28+ days)

Process complex, difficult, and non-routine claims for multiple lines of business

Audit work of assigned claims examiners to ensure accuracy.

Identify policies of common errors requiring retaining sessions

Assist with retraining sessions as directed.

Participate in quality projects as required by management.

Required Education, Training & Professional Experience

Bachelor’s degree is required; a Master’s degree is preferred, or an equivalent combination of education and relevant experience that demonstrates satisfactory equivalency.

At least three (3) years’ experience of claims in a managed care or hospital setting is required.

Strong data entry skills are essential.

In-depth knowledge of adjustment processing, medical terminology, CPT, ICD‑P, and revenue codes is required.

Proficiency in Microsoft Office applications, including Word, Excel, and Access, is required.

Must be capable of performing all duties and responsibilities of Claims Examiners within the department.

Professional Competencies

Integrity and Trust

Customer Focus

Functional/Technical skills

Written/Oral Communication

Must be able to communicate adequately both verbal & written

Must have excellent interpersonal skills

#LI-Hybrid

#MHP50