Claims Processor

Job Description

Job Description

Job Title: Claims Processor

Location: New York City, NY 10004 (Hybrid)

Schedule: Full-Time, 35 hours/week

Shift: Monday – Friday | 9:00 AM – 5:00 PM

Pay Rate: $30.00/hr. to $33.00/hr.

Job Summary

We are seeking an experienced Claims Processor to join the team. This role is responsible for the accurate and timely processing of provider medical claims, ensuring compliance with company policies and contractual guidelines. The ideal candidate will have experience in healthcare insurance claims processing, medical terminology, coding, and data entry.

Key Responsibilities

Process medical and surgical provider claims accurately and efficiently.

Review claims for complete member and provider information.

Apply administrative policies and claims processing guidelines.

Audit and validate claims for accuracy and identify billing or payment errors.

Review CPT, ICD, and Revenue Codes to determine claim validity.

Evaluate and resolve claims pended due to contractual or payment discrepancies.

Generate provider correspondence and requests for additional documentation when needed.

Maintain daily productivity and quality standards.

Update claims processing manuals and reference materials as required.

Attend departmental training and refresher sessions.

Perform other duties as assigned.

Required Qualifications

Associate's Degree or an equivalent combination of education and relevant experience.

Minimum 2 years of healthcare insurance claims processing experience.

Experience with integrated claims processing.

Strong data entry skills with excellent attention to detail.

Knowledge of:

Medical Terminology

CPT Codes

ICD Codes

Revenue Codes

Intermediate proficiency with Microsoft Office and PC applications.

Strong analytical, problem-solving, decision-making, and time management skills.

Required Skills

Healthcare Claims Processing

Integrated Claims Processing

Claims Auditing

Medical Terminology

CPT & ICD Coding

Revenue Codes

Data Entry

Claims Review & Adjudication

Payment Discrepancy Resolution

Quality Assurance

Time Management

Problem Solving

Updating Claims Manuals

Microsoft Office

Education

High School Diploma or GED required.

Associate's Degree preferred or an equivalent combination of education and experience.

Ideal Candidate

The ideal candidate has hands-on experience processing healthcare insurance claims, understands medical coding and terminology, can work independently in a high-volume environment, and consistently meets productivity and quality standards while ensuring accurate claims adjudication.

Company Description

Pride Health offers eligible employee’s 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, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity
Pride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment
Pride Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.

Company Description

Pride Health offers eligible employee’s 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, pet insurance and employee discounts with preferred vendors.\r\n\r\nEqual Employment Opportunity\r\nPride Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.\r\n\r\nFair Chance Employment\r\nPride Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.\r\n\r\nAccommodations\r\nWe are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.\r\n\r\nOnly applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.\r\n\r\nOnly applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.