Claims Service Correspondent

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 30 years, MetroPlusHealth has been committed to building strong relationships with its members and providers to enable New Yorkers to live their healthiest life.

Position Overview

The Claims Service Correspondent is responsible for accurate and timely response 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.

• Act as a key liaison and service representative 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 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.

• High School Diploma required.
• Minimum 2 years of experience in claims processing protocols and payment schemes.
• 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

#LI-Hybrid