Claims Handler

Job Summary:This 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 Responsibilities:Act 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 ServicesRequired 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 underpaymentsEducation:Qualifications 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 experience