Current jobs related to Team Lead, Inpatient Claims Pricing Specialist - New York - Med Review Inc
-
Claims Specialist Lead
2 weeks ago
New York County, New York, United States Gallagher Full timeAbout the Role:Gallagher is seeking a highly skilled Claims Specialist Lead to join our team in a Construction Defect Claims role. As a key member of our team, you will be responsible for investigating, evaluating, and resolving complex liability claims in one or more of Gallagher's specialty claims areas.Key Responsibilities:Investigate and evaluate complex...
-
Claims Specialist
3 days ago
New York, New York, United States Northwell Health Full timeJob SummaryWe are seeking a skilled Claims Specialist to join our team at Northwell Health. As a Claims Specialist, you will be responsible for performing various billing, collection, and third-party reimbursement functions.Key ResponsibilitiesReview and investigate claims to be adjudicated by the TPA, ensuring compliance with provider contracts and...
-
Actuarial Analyst
3 weeks ago
New York, New York, United States Argo Group Full timeJob SummaryArgo Group is a leading provider of specialty insurance solutions, and we're seeking an experienced Actuarial Analyst - Pricing Specialist to join our team. As a key member of our actuarial team, you will play a critical role in supporting the development of our pricing strategy and ensuring the accuracy and reliability of our actuarial models.Key...
-
Lead Actuarial Pricing Specialist
4 weeks ago
New York, New York, United States Argo Group Full timeJob OverviewArgo Group stands at the forefront of specialty insurance, fostering a dynamic environment grounded in respect, equality, wellness, and opportunity. We pride ourselves on being an innovative entity that balances agility with the capacity to effect meaningful change within our sector.Our adaptable workplace is designed to ensure that every...
-
Claims Handler
4 weeks ago
New York, New York, United States Sovereign Claims, LLC Full timeJob SummarySovereign Claims, LLC is seeking a highly skilled Claims Handler to join our team. As a Claims Handler, you will be responsible for investigating and supervising outsourced investigations of CGL insurance claims and lawsuits related to construction projects.Key ResponsibilitiesInvestigation and Supervision: Conduct thorough investigations of CGL...
-
Claims Specialist
3 days ago
New York, New York, United States AXIS Capital Holdings Limited Full timeClaims Specialist Job DescriptionAXIS Capital Holdings Limited is seeking a skilled Claims Specialist to join our team. As a Claims Specialist, you will play a critical role in analyzing and resolving claims in a best practices claim environment.Key Responsibilities:Exercise critical thinking and proper judgment to analyze claim exposure and determine the...
-
Actuarial Analyst
3 weeks ago
New York, New York, United States Argo Group Full timeJob Description**About Argo Group**Argo Group is a leading provider of specialty insurance products in the property and casualty market. We offer a full line of products and services designed to meet the unique coverage and claims-handling needs of businesses.**Job Summary**We are seeking an experienced Actuarial Analyst - Pricing Specialist to join our...
-
Healthcare Liability Claims Team Lead
2 weeks ago
New York, New York, United States QBE Americas, Inc. Full timeJob SummaryWe are seeking a seasoned leader to spearhead our Healthcare Liability Claims team. As a Senior Claims Manager, you will be responsible for overseeing the operational and technical aspects of the team, driving best practices, and fostering a culture of excellence.Key ResponsibilitiesDevelop and implement effective methods and procedures to manage...
-
Pricing Specialist
11 minutes ago
New York, New York, United States FIS Full timeAbout the RoleFIS is seeking a skilled Pricing Specialist to join our team. As a Pricing Specialist, you will play a critical role in developing and implementing pricing strategies that drive revenue growth and profitability for our clients.Key ResponsibilitiesDevelop and maintain complex financial models to analyze market trends and customer...
-
Lead Claims Specialist
4 weeks ago
New York, New York, United States C. Winchell Agency, Inc. Full timeSenior Claims AdvocateProperty & Casualty Insurance SectorLocation: Essex County, NJDeliver exceptional claims support in the daily management of Property and Casualty claims and associated matters. Focus areas include personal lines such as auto and homeowners insurance, along with sectors like construction, transportation, and real estate.Key...
-
Claims Handler ll
4 months ago
New York, United States Sovereign Claims, LLC Full timeJob DescriptionJob DescriptionKey Responsibilities:Personally investigate and/or supervise outsourced investigations of CGL insurance claims and lawsuits, both bodily injury and property damage, arising out of construction projects in the greater New York City metropolitan area within New York State. Obtain necessary information from every possible source,...
-
Health Claims Specialist
3 days ago
New York, New York, United States Lower Eastside Service Center Full timeJob Title: Health Claims SpecialistWe are seeking a skilled Health Claims Specialist to join our team at the Lower Eastside Service Center. As a Health Claims Specialist, you will be responsible for processing routine Institutional and Professional claims, investigating pending claims, resolving discrepancies, and reviewing insurance coverage.Key...
-
MCO Claims Specialist
3 months ago
New York, United States CorVel Corporation Full timeThe MCO Claims Specialist is responsible for weekly oversight of MoD performance and updates for entire claim department. The position will address all non-CorVel claims accordingly. The Claim Specialist role includes managing and retaining an assigned BoB (# of EOR and premium amount). The BoB will be comprised of lower premium employers with little to no...
-
Insurance Claims Specialist
4 weeks ago
New York, New York, United States Collabera Full timeJob OverviewPosition Title: Insurance Claims SpecialistWork Arrangement: RemoteContract Duration: 7+ monthsCompensation: $18 - $20 per hourRole Summary:The Insurance Claims Specialist will be responsible for managing Travel Insurance Claims. An active adjuster's license from New York state is mandatory, and possessing licenses from multiple states is highly...
-
Lead Claims Specialist
4 weeks ago
New York, New York, United States Tandym Group Full timeA prominent healthcare organization is in search of a Senior Claims Analyst. This position entails managing intricate claims operations and ensuring the satisfaction of healthcare providers.Key Responsibilities:Oversee comprehensive claims processing workflowsEnsure quality assurance for external claims administratorsAddress and resolve concerns related to...
-
NYLL Senior Claims Specialist
2 weeks ago
New York County, New York, United States Gallagher Full timeAbout the Role:Gallagher is seeking a highly skilled Senior Claims Specialist to join our team. As a Senior Claims Specialist, you will be responsible for investigating, evaluating, and resolving complex liability claims in one or more of Gallagher's specialty claims areas.Key Responsibilities:Investigate and evaluate complex liability claims to determine...
-
Claims Processing Specialist
4 weeks ago
New York, New York, United States Barasch & McGarry Full timeJob OverviewOBJECTIVE:The Claims Processing Specialist is responsible for the efficient management and processing of clients' Victim Compensation Fund claims. This role requires close collaboration with the VCF Team to ensure precise claim submissions and to optimize the awards for clients.KEY RESPONSIBILITIES:Manage and process claims assigned by Team...
-
Claims Review Specialist
7 days ago
New York, New York, United States City of New York Full timeJob SummaryWe are seeking a highly skilled Claims Review Specialist to join our team at the City of New York. As a Claims Review Specialist, you will be responsible for reviewing and processing claims for potential SNAP benefit overpayments.Key ResponsibilitiesReview and process claims for potential SNAP benefit overpayments using USDA/FNS/OTDA SNAP benefit...
-
Claims Resolution Specialist
3 weeks ago
New York, New York, United States GB - Global Full timeAbout the RoleWe are seeking a skilled Claims Resolution Specialist to investigate, evaluate, and resolve complex liability claims in one or more of our specialty claims areas. As a key member of our team, you will work closely with our clients, using your analytical skills to make decisions and bring claims to resolution.Key ResponsibilitiesInvestigate and...
-
Claims Review Specialist
2 weeks ago
New York, New York, United States City of New York Full time{"title": "Claims Review Specialist", "subtitle": "Join Our Team", "content": "At the City of New York, we are seeking a highly skilled Claims Review Specialist to join our team. As a Claims Review Specialist, you will be responsible for reviewing, processing, and determining potential SNAP benefit overpayments. You will apply USDA/FNS/OTDA SNAP benefit...
Team Lead, Inpatient Claims Pricing Specialist
3 months ago
Position Summary
At MedReview, our mission is to bring accuracy, accountability and clinical excellence to healthcare. As such, we are a leading authority in payment integrity solutions including DRG Validation, Cost Outlier and Readmission reviews.
Pricing and analysis of inpatient medical claims utilizing NYCHSRO/MedReview and payer specific systems, adjudication platforms, policies, and procedures. Provide support to various departments related to claim status, claim adjudication questions, and any basic questions related to the adjudication of an inpatient medical claim.
Candidate should be highly motivated, with strong pricing background including experience in platforms such as Facets, Webstrat, and Encoder. This individual must have excellent communication skills, must be analytical, have strong problem solving skills, and have the ability to make quality decisions.
This is a fulltime position (40 hours per week) Monday – Friday. You’ll enjoy the flexibility to telecommute from anywhere within the United States. Training will be conducted virtually from your home.
Responsibilities:
This list does not represent all responsibilities for this position. Candidate must understand and be willing and able to assume roles and responsibilities other than these to meet the needs of MedReview Operations in general.
Serves as a knowledge expert and maintains up to date working knowledge of pricing guidelines in order to act as a resource for all pricing team members.
Responsible for reviewing data in the review application and client claim processing system, and comparing with corresponding UB, medical record or other documentation.
Responsible for reviewing all necessary documentation as necessary to determine appropriate reimbursement for a claim.
Responsible for reviewing adjudication software system’s claim and line items for determination of how to price a claim / line item.
Possess ability to work at a computer for extended periods.
Performs quality reviews on individual team members ensuring all claims are completed timely and per department standards.
Identifies education needs within the department to facilitate pricing accuracy improvement.
Works collaboratively with Assistant Director of Pricing to analyze and optimize processes to maintain acceptable productivity rates for each individual team member.
Works collaboratively with Assistant Director in developing educational tools for new hire orientation and ongoing department education.
Other duties as assigned.
Qualifications:
Associates degree preferred.
Minimum of 5 years management experience
Minimum of 5 years related work experience. Prior experience with claim adjudication systems, grouping and pricing software, and other claim adjudication and claim pricing systems. Ie; Facets, Cosmos, CAS, WebStrat, Encoder.
Experience with pricing reject resolution
Basic knowledge of medical terminology.
Good knowledge of Microsoft Word, Excel and Outlook
Intermediate mathematics aptitude
Good communication skills
Good organizational abilities
Good comprehension capabilities
Ability to prioritize multiple tasks
Experience with UB/institutional claims
Knowledge of Medicare and Medicaid billing & payment and coverage guidelines
Strong experience in the analysis and processing of claims, quality assurance, CMS payment methodologies (i.e., DRGs, Cost Outliers)
Must be able to work with minimal supervision
Creative thinker with good skills at problem resolution specifically related to healthcare claim adjudication
High speed internet (300 Mbps per person recommended) with secured WIFI.
Benefits and perks include:
Healthcare that fits your needs
- We offer excellent medical, dental, and vision plan options that provide coverage to employees and dependents.
401(k) with Employer Match
- Join the team and we will invest in your future
Generous Paid Time Off
- Accrued PTO starting day one, plus additional days off when you’re not feeling well, to observe holidays.
Wellness
- We care about your well-being. From Commuter Benefits to FSAs we’ve got you covered.
Learning & Development
- Through continued education/mentorship on the job and our investment in LinkedIn Learning, we’re focused on your growth as a working professional.
Salary: 58k-68k
#J-18808-Ljbffr