Claims Adjustment Specialist I

Job Title: Claims Adjustment Specialist I (Healthcare Claims)

Location: New York, NY 10004 (Hybrid)
Duration: 32-Week Contract
Schedule: Monday–Friday | 9:00 AM – 5:00 PM | 35 Hours/Week
Pay Range: $27.00 to $31.50/hour based on experience, education and credentialing

Job Summary

We are seeking an experienced Claims Adjustment Specialist I to research, analyze, and adjust medical claims for overpayments, underpayments, and processing errors. The ideal candidate will have strong healthcare claims experience, knowledge of medical coding, and the ability to work independently in a fast-paced environment.

Responsibilities

• Review and analyze medical claims to determine payment accuracy.
• Process claim adjustments for overpayments, underpayments, and billing errors.
• Apply CMS, Medicare, Medicaid, and health plan guidelines during claim adjudication.
• Research claim discrepancies and communicate findings with providers and internal teams.
• Respond to provider inquiries regarding claim payments and required documentation.
• Maintain accurate claim records and process adjustments within required timelines.
• Generate reports and support claim audits.
• Stay current on claims processing policies, coding updates, and reimbursement guidelines.

Qualifications

• High School Diploma or GED required; Associate Degree preferred.
• 3+ years of healthcare claims operations experience required.
• Experience with claim adjudication systems and medical claims processing.
• Knowledge of CPT, ICD-10, Revenue Codes, HCFA, UB-04, and HIPAA guidelines.
• Experience with CRM software (Salesforce preferred).
• Strong analytical, problem-solving, and communication skills.
• Proficient in Microsoft Excel and Word.
• Experience handling provider claim inquiries is highly preferred.

Pride-Health offers eligible employee’s comprehensive healthcare coverage (medical, dental, and vision plans), supplemental coverage (accident insurance, critical illness insurance and hospital indemnity), 401(k)-retirement savings, life & disability insurance, an employee assistance program, legal support, pet insurance and employee discounts with preferred vendors.

Equal Employment Opportunity
Pride-Health is an equal opportunity employer. We do not discriminate on the basis of the race, religious creed, color, national origin, ancestry, physical disability, mental disability, reproductive health decision making, medical condition, genetic information, marital status, sex, gender, gender identity, gender expression, age, sexual orientation, veteran or military status, or any other characteristic protected by applicable federal, state, or local law.

Fair Chance Employment
Pride-Health is a Fair Chance employer. We consider all qualified applicants, including those with criminal histories, in a manner consistent with applicable state and local Fair Chance laws and ordinances, including, the California Fair Chance Act and all applicable local Fair Chance ordinances.

Accommodations
We are committed to providing reasonable accommodations to applicants and employees with disabilities. If you require a reasonable accommodation to participate in the application or interview process, or to perform the essential functions of this role, please contact us.

Only applicable for San Francisco Candidates: Under the San Francisco Lactation in the Workplace Ordinance, we will provide written notice of lactation accommodation rights, and this notice will automatically be given upon hiring, any inquiry of parental leave or lactation accommodation.

Only applicable for Kentucky positions: For this type of employment, state law requires a criminal record check as a condition of employment. This applies to direct care staff (Examples: RN, LPN, Nurse Aides, Therapists) referred to Kentucky nursing facilities, assisted living communities, or long-term care facilities, in accordance with KRS 216.793.

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