Claims Specialist 253481
5+ years
Jericho, NY
Contract
Onsite
1 month ago
About the role
Claims Specialist
Employment Type: Indefinite Contract
Location: Jericho, NY (Remote options available)
Schedule: Monday–Friday | 8:00 AM – 5:30 PM
Hours: 40 hours/week
Start Date: 05/31/2026
Pay Rate:
About the Role
We are seeking detail-oriented and motivated Claims Specialists to support clinical review and appeal/dispute adjudication programs. This role is responsible for coordinating healthcare claims review activities, tracking case progress, communicating with stakeholders, and ensuring timely completion of deliverables.
Key Responsibilities
Required Qualifications
Employment Type: Indefinite Contract
Location: Jericho, NY (Remote options available)
Schedule: Monday–Friday | 8:00 AM – 5:30 PM
Hours: 40 hours/week
Start Date: 05/31/2026
Pay Rate:
- Onsite: $22–$28/hr
- Remote: $22–$25/hr
About the Role
We are seeking detail-oriented and motivated Claims Specialists to support clinical review and appeal/dispute adjudication programs. This role is responsible for coordinating healthcare claims review activities, tracking case progress, communicating with stakeholders, and ensuring timely completion of deliverables.
Key Responsibilities
- Serve as the primary point of contact for appeal and dispute adjudication programs
- Coordinate communication between healthcare plans, providers, patients, and internal teams
- Monitor appeal/dispute statuses and communications through client portals
- Conduct initial eligibility reviews and escalate recommendations as appropriate
- Track and assign cases using internal and commercial software systems
- Review and distribute case documentation to coders, billers, nurses, physicians, and clinical teams
- Monitor key performance indicators including quality, timeliness, and contract deliverables
Required Qualifications
- Associate’s or Bachelor’s degree in: Healthcare, Business, Management, Digital Studies, or related field
- Minimum 2 years of healthcare claims, or comparable experience
- Experience using project management software and electronic documentation systems
Skills
AdministrativeAdministrative and Support Services