Healthcare Claims Specialist

3 days ago


New York, New York, United States Centers Plan for Healthy Living Full time
Job Summary
Centers Plan for Healthy Living (CPHL) is seeking a Healthcare Claims Specialist to join our team. As a Claims Resolution Coordinator, you will be responsible for handling incoming inquiries from providers regarding claim decisions and payments across all CPHL product offerings.

Key Responsibilities:
  • 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.
  • Meet or exceed performance goals established for the position in the areas of: efficiency, call quality, provider satisfaction, first call resolution and attendance.


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