Data Quality Analyst / Claims Service Correspondent

Job Title: Data Quality Analyst / Claims Service CorrespondentLocation: New York, NY 10004Duration: 04/27/2026 – 06/20/2026Shift: 9:00 AM – 5:00 PMSchedule: 5 days/week, 7 hrs/day, 35 hrs/week, No on-callSchedule Notes: Candidate requirements: Work Schedule: Full time; Hours Per Week: 35; Days: Monday, Tuesday, Wednesday, Thursday, Friday; Shift time: 9am - 5pm; Work location: Hybrid; Patient Facing: No; Position Overview: This position is responsible for the accurate and timely response to written claim inquiries received from providers. Incumbent provides support regarding the adjudication and adjustment of claims for the multiple lines of business. The incumbent works closely with Provider Relations, Medical Management, Member Services and the Claims Processing unit; Scope of Role & Responsibilities: Act as a key liaison and service representative for all written provider inquiries and problem resolution; Respond to all claim inquiries from provider sites personnel 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); Manage and ensure appropriate follow-up and closure for all inquiries; Respond to Provider Inquiries in writing; maintain accurate files; Data Entry into the IMAX system; Perform claim adjustments to correct erroneous payments (overpayments/underpayments); Participate in Special Projects involving Claim Status Investigations; Resolve Member Bills referred from Member Services; Required Education, Training & Professional Experience: In-depth knowledge of MetroPlus Claims Processing protocols and payment schemes; Thorough knowledge of Plan Benefits; Proficiency in IMAX and TXEN; Customer Service Experience a plus; Must be able to handle irate providers in a professional manner; Excellent written/verbal communication skillsWork Setting: Managed Care / Health PlanPay Range: $60-$65/hr.RequirementsRequired Skills & Experience:In-depth knowledge of MetroPlus Claims Processing protocols and payment schemesThorough knowledge of Plan BenefitsProficiency in IMAX and TXENHigh volume inquiries experienceClaims adjustment / claim adjuster experienceStrong customer service skillsProblem solving and follow-up management skillsIssue resolutionAbility to handle irate providers professionallyExcellent written and verbal communication skillsData entry experience and maintaining accurate filesExperience responding to provider inquiries including physicians, clinical staff, and administratorsExperience coordinating with internal departments including claims and utilization managementExperience performing claim adjustments for overpayments and underpaymentsEducationQUALIFICATIONS FOR THE JOB:NYC Residency PreferredEDUCATIONAL LEVEL:A Master's degree in Public or Business Administration or in an equivalent or equally acceptable program and four (4) years of experience in a major governmental agency or large corporation or foundation in management analysis or in operational direction, planning, coordination or control of which, two years must have been in a supervisory, administrative or consultative capacity; ORBachelor's degree from an accredited college or university and five (5) years of experience as described above, of which three (3) years must have been in a supervisory, administrative or consultative capacity; ORA satisfactory equivalent combination of training, education and/or experienceCertifications & LicensureNoneJob SummaryThis position is responsible for the accurate and timely response to written claim inquiries received from providers and provides support regarding the adjudication and adjustment of claims for multiple lines of business. Works closely with Provider Relations, Medical Management, Member Services, and Claims Processing units.Job ResponsibilitiesAct as a key liaison and service representative for all written provider inquiries and problem resolutionRespond to all claim inquiries from provider site personnel including physicians, clinical staff, and site administratorsCoordinate and track appropriate problem resolution activities with internal departmentsManage and ensure follow-up and closure for all inquiriesRespond to provider inquiries in writing and maintain accurate filesPerform data entry into IMAX systemPerform claim adjustments to correct erroneous payments (overpayments/underpayments)Participate in special projects involving claim status investigationsResolve member bills referred from Member Services