Claims Support Specialist
The Claims Support Specialist provides support to health plan members, providers, and third party adjudicators to ensure understanding of benefits and accuracy, timeliness, and appropriateness of claims payments. This full-time position is located in Syracuse, NY, Monday through Friday, 8:00 AM to 4:30 PM.
About the Role
Nascentia Health is a healthcare system focused on home care, post-acute care, and long-term community health. The organization aims to provide holistic care by serving patients in their homes, leveraging innovative in-home care technologies, and avoiding unnecessary facility visits.
Responsibilities
- Works directly with third-party administrators to resolve authorization, contract, and eligibility issues.
- Responds to and records inquiries from members, providers, and consumers regarding coverage and claim payments for Medicaid and Medicare plans.
- Collaborates with other health plan departments and vendors to ensure claims are processed according to agency guidelines and policies.
- Conducts regular reviews of claims based on plan needs.
- Documents and communicates issues related to claims adjudication to supervisors promptly.
- Provides assistance and guidance to members and providers regarding billing and payments.
- Participates in performance improvement and CQI activities.
- Affirms compliance with department and professional standards, including HIPAA and privacy requirements.
- Delivers courteous, responsive, respectful, and knowledgeable customer service.
- Performs other duties as assigned.
Requirements
- High School Diploma or equivalent required.
- Skilled in prioritizing, problem-solving, multi-tasking, and meeting deadlines.
- Insurance experience, with knowledge of Medicare benefits preferred.
- Exceptional customer service skills.
- Demonstrates discretion in handling confidential and sensitive information.
- Excellent communication skills, both verbal and written.
Physical Requirements
- Speaking, visual, and hearing ability sufficient to comprehend and express written/verbal communication.
- Extended periods of computer use.
- Ability to sit or stand at a desk 90% of the day.
- Extended periods of computer use.
- Ability to lift and move objects up to 40 pounds.
Compensation & Benefits
- Competitive salary with retention bonuses, internal mentoring program, 401K with generous employer match, on-site gym, medical, dental, vision plans, tuition reimbursement, partially funded HSA, employee recognition platform, paid time off, holidays, sick and extended sick leave, short and long-term disability, and EAP.
About Nascentia Health
Nascentia Health is committed to providing holistic care in the comfort of patients' homes. The organization focuses on home care, post-acute care, and long-term community health, leveraging innovative technologies and avoiding unnecessary facility visits. Employees are encouraged to love their work, be excited about coming to work, and take pride in being part of the team.
Equal Opportunity Employer
Employment is contingent upon negative results of a pre-hire drug screen and background check clearance.