New York Licensed Claims Specialist

A company is looking for a Medical Claims Resolution Specialist II, Appeals.

Key Responsibilities

Negotiate healthcare claims and maintain provider relationships to achieve maximum discounts

Perform claim research and manage a high volume of healthcare claims while meeting departmental performance metrics

Communicate effectively with providers to address counteroffers and facilitate successful resolutions

Required Qualifications and Education

Minimum high school diploma or GED

At least 2 years of experience in a service-based industry, preferably in healthcare or medical insurance

State licensure certification may be required, with a six-month timeline to obtain if not already certified

Knowledge of medical coding systems and general office operations

Ability to work independently and handle confidential information in a fast-paced environment