Adjudication, Claims Management, Claims Processing, Compensation and Benefits, Contract Management, Customer Support/Service, Data Entry, Health Plan, Healthcare Providers, High School Diploma, Mail Processing, Payment Processing, Presentation/Verbal Skills, Problem Solving Skills, Provider Contracting, Retro, Time Management, Utilization Management
Claims Service Correspondent
Job Ref: TE0167
Category: Claims
Department: CLAIMS
Location: 50 Water Street, 7th Floor, New York, NY 10004
Job Type: Regular
Employment Type: Full-Time
Work Arrangement: Hybrid
Salary Range: $55,000.00 - $64,518.00
Position Overview
The Claims Service Correspondent is responsible for accurate and timely responses to written claim inquiries received from providers. This individual provides support regarding the adjudication and adjustment of claims for multiple lines of business. They will work closely with Provider Contracting, Medical Management, Enrollment and Membership department, and Claims Processing unit.
Scope of Role & Responsibilities
- Act as a key liaison and service representatives for all written provider inquiries and problem resolution.
- Respond to all claim inquiries from provider sites including physicians, clinical staff, and site administrators.
- Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., Claims, Utilization Management, etc.)
- Manage and ensure appropriate follow-up and closure for all inquiries.
- Respond to providers' inquiries in writing and maintain accurate tracking.
- Data entry into the Claims Processing and Correspondence Distribution systems.
- Perform claim adjustments to correct erroneous payments (overpayments/underpayments).
- Perform claim adjustments due to Authorization Appeals and Retro Reviews.
- Participate in special projects involving Claim Status Investigations.
- Resolve Member Bills referred from Member Services.
Required Education, Training & Professional Experience
- High School Diploma required.
- Minimum 2 years of experience in claims processing protocols and payment schemes.
- Proficiency working in a comparable Claims Processing Database.
- Thorough knowledge of health benefits plans.
- Must be able to resolve concerns with providers in a professional manner.
Professional Competencies
- Integrity and Trust
- Customer Service Focus
- Functional/Technical skills
- Written/Oral Communication
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Metroplus Health Plan Inc