Claims Resolution Coordinator

3 days ago


New York, New York, United States Centers Plan for Healthy Living Full time
About Us
Centers Plan for Healthy Living (CPHL) is a Managed Care Organization servicing members with Medicare and/or Medicaid. Our goal is to provide members and all those involved in their care with the guidance and health plan choices they need for healthy living.

We are committed to providing quality, coordinated healthcare to some of the most honored and yet still vulnerable members of our community. Our team members are the backbone of our organization, and we prize collaboration and mutual respect, high ethical and moral standards, and always seek to provide the highest level of customer care to all of our customers.

Job Description
This role involves handling incoming inquiries from providers regarding claim decisions and payments across all CPHL product offerings. The ideal candidate will have excellent communication and problem-solving skills, as well as the ability to work independently and collaboratively as part of a team.

The successful candidate will be able to:Professionally handle incoming inquiries via telephone, email or fax from providers (i.e. physician offices, clinics, social day cares, home care agencies, DME suppliers) regarding claim decision and payments.Thoroughly and efficiently gather claim information, assess and fulfill the caller's needs and educate the caller where applicable regarding claim submission procedures.Foster positive relationships with providers by delivering all information and questions in a positive, conversational and compassionate manner.

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