Claims Assistant

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OtherAssistant

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Quick Summary

Key Responsibilities

Accurately enter claim submissions, claim reconsiderations, Complaints & Grievances, and special project claims into the EZ-CAP claims system.

Requirements Summary

Accurately enter claim submissions, claim reconsiderations, Complaints & Grievances, and special project claims into the EZ-CAP claims system.

Technical Tools

OtherAssistant

HealthCare Partners, IPA and HealthCare Partners, MSO together comprise our health care delivery system providing enhanced quality care to our members, providers and health plan partners. Active since 1996, HealthCare Partners (HCP) is the largest physician-owned and led IPA in the Northeast, serving the five boroughs and Long Island. Our network includes over 6,000 primary care physicians and specialists delivering services to our 125,000 members enrolled in Commercial, Medicare and Medicaid products. Our MSO employs 165+ skilled professionals dedicated to ensuring members have access to the highest quality of care while efficiently utilizing healthcare resources.

HCP’s vision is to be recognized by members, providers and payers as the organization that delivers unsurpassed excellence in healthcare to the people of New York and their communities. We pride ourselves on selecting the most qualified candidates who reflect HCP’s mission of serving our members by facilitating the delivery of quality care. Interested in joining our successful Garden City Team? We are currently seeking a Claims Assistant!

Position Summary: The Claims Assistant supports the Claims and Complaints & Grievances departments by performing administrative, data entry, and claims support functions. This position is responsible for the accurate and timely entry, tracking, and processing of claims-related information while ensuring compliance with departmental procedures, quality standards, and regulatory requirements. The Claims Assistant works closely with Claims Examiners, Customer Service, Utilization Management, and Provider Services to support efficient claims operations.

Essential Position Functions/Responsibilities:

Accurately enter claim submissions, claim reconsiderations, Complaints & Grievances, and special project claims into the EZ-CAP claims system.
Review and verify claim information to ensure complete and accurate claim registration.
Perform basic claim adjustments and updates according to established procedures.
Assist with pharmacy claim pricing using approved databases and resources.
Request, track, and coordinate medical records and supporting documentation for claims review.
Contact provider offices to obtain missing claim information, referrals, authorizations, and provider details.
Review notifications from Utilization Management, create claims as needed, and notify Claims Examiners of claims requiring processing.
Review, update, and close Customer Service incidents related to claims inquiries and processing.
Assist with the processing and tracking of Complaints & Grievances to ensure timely resolution.
Maintain electronic records and documentation in accordance with departmental procedures.
Meet established productivity, quality, and turnaround time standards.
Maintain a minimum quality standard of 98% procedural accuracy.
Comply with HIPAA, company policies, and applicable regulatory requirements.
Participate in overtime, evening, or weekend schedules as needed to meet operational and compliance requirements.
Perform other duties as assigned.

Qualification Requirements:
Skills, Knowledge, Abilities

Basic knowledge of medical terminology, healthcare claims processing, or insurance operations preferred.
Familiarity with ICD-10 diagnosis coding and CPT/HCPCS procedure coding preferred.
Strong data entry skills with excellent attention to detail.
Proficiency in Microsoft Office applications, including Word, Excel, and Outlook.
Strong verbal and written communication skills.
Ability to work in a fast-paced, production-driven environment.
Strong organizational and time-management skills.
Ability to prioritize tasks and meet deadlines.
Ability to work independently and as part of a team.

Training/Education:

High School Diploma or GED required.
Coursework or training in healthcare administration, medical billing and coding, or a related field is a plus.

Experience:

Minimum one (1) year of data entry or administrative experience, preferably in a healthcare or insurance environment.
Previous claims, medical billing, customer service, or healthcare administrative experience preferred.
Experience with EZ-CAP or other healthcare claims systems is a plus.

Base Compensation: $21.00 - $22.50 per hour

Equal Employment Opportunity Statement:
HealthCare Partners, MSO is committed to fostering a diverse and inclusive workplace. We provide equal employment opportunities (EEO) to all employees and applicants without regard to race, color, religion, sex, national origin, age, disability, genetics, or any other protected status under federal, state, or local laws. In compliance with all applicable laws, HealthCare Partners, MSO upholds a strict non-discrimination policy in every location where we operate. This policy applies to all aspects of employment, including but not limited to recruitment, hiring, placement, promotion, termination, layoff, recall, transfer, leaves of absence, compensation, and training.

Job Disclaimer:
The above job description outlines the general scope and responsibilities of the position. It is not intended to be an exhaustive list of duties, skills, or qualifications required. Responsibilities may evolve based on business needs.

Department: Claims
This is a non-management position
This is a full time position

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