Claims Service Specialist

3 weeks ago


New York, New York, United States Centers Plan for Healthy Living Full time
Overview
Centers Plan for Healthy Living is a healthcare organization that empowers its members and their families with guidance and plans for healthy living. We strive to create a positive experience for our customers and believe in the importance of collaboration, mutual respect, and high ethical standards.

Job Description
We are seeking a skilled Claims Service Specialist to join our team. In this role, you will handle incoming inquiries from providers regarding claim decisions and payments. You will gather claim information, assess and fulfill caller needs, and educate on claim submission procedures. Your primary goal will be to resolve issues on the first call by navigating through computer systems to identify issue status. You will also adjust claims as needed and deliver information and questions in a positive and compassionate manner to develop relationships with providers. Additionally, you will transfer calls to other business units for further resolution, document provider issues, and report overall trends. You will maintain phone and contact logs, and document call details. Meeting performance goals in efficiency, call quality, provider satisfaction, first call resolution, and attendance is crucial to success in this role. A strong understanding of CPHL products and applicable state and federal regulations is essential. Salary: $19.49 - $23.08 per hour.

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