Claims Specialist

Claims Specialist at Pride Health Claims Specialist at Pride Health in Hoboken, New Jersey Posted in 10 days ago.

Type:

full-time

Job Description:

Position:

Claims Adjustment Specialist I Location:

New York, NY 10004

Job Type:

Contract Contract:

8 weeks (with potential extension)

Schedule:

Monday-Friday | 9:00 AM - 5:00 PM (Hybrid) Guaranteed hours per week: 35.00

Pay:

Up to $30/hour Job Summary Pride Health is seeking an experienced Claims Adjustment Specialist I for a contract opportunity in New York, NY. This role is responsible for reviewing, analyzing, and adjusting medical claims to ensure accurate payment processing in compliance with healthcare guidelines and policies. Responsibilities

• Research and analyze medical claims adjustment requests and supporting documentation
• Adjust and adjudicate claims for overpayments or underpayments
• Apply appropriate payment guidelines including CMS, Medicare, Medicaid, and plan benefits
• Identify claim discrepancies related to coding, reimbursement rates, or authorizations
• Communicate findings and resolutions to internal teams and external providers
• Respond to provider inquiries regarding claims processing and payment issues
• Maintain accurate documentation and records of all claims processed
• Generate reports on claim activity and assist with audits
• Ensure timely processing of claim adjustments according to established timelines
• Stay updated with changes in claims processing guidelines and coding standards
• Utilize multiple systems including CRM tools (Salesforce preferred) and claims platforms Requirements
• Minimum 3 years of experience in healthcare claims operations
• Strong knowledge of medical claims processing and adjudication
• Familiarity with CPT, ICD-10, and Revenue Codes
• Experience with claims systems and CRM tools (Salesforce preferred)
• Strong analytical, problem-solving, and decision-making skills
• Proficiency in Microsoft Excel and Word
• Excellent communication and documentation skills Preferred Qualifications
• Associate degree preferred (High School Diploma/GED required)
• Experience with HCFA and UB-04 claim forms
• Knowledge of HIPAA regulations and compliance
• Experience handling provider inquiries and claim investigations
• Ability to work independently and manage multiple priorities Why Work with Pride Health?

Pride Health offers eligible employees 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, auto and home insurance, pet insurance, and employee discounts with preferred vendors.