• Job Description

  Req#: 500271
  Grounded by a compelling mission, core values, and compassion for people, CDPHP and its family of companies offer a strong foundation for a rewarding career. Established in 1984, CDPHP is a physician-founded, member-focused, and community-based not-for-profit health plan that offers high-quality affordable health insurance to members throughout New York. The company values people, quality, innovation, and community, and its corporate culture supports those values wholeheartedly. CDPHP is committed to fostering a culture of belonging and takes a wholistic approach to diversity, equity, and inclusion. At CDPHP, the employees have a voice and are encouraged to make an impact at both the company and community levels through engagement and volunteer opportunities. CDPHP invests in employees who share these values and invites you to be a part of that experience.
  
  The Claims Data Specialist is primarily responsible for ensuring that all claims affected by retrospective configuration changes and other various requests are adjusted appropriately. This includes meeting facilitation, coordination of automated adjustments, some reporting interpretation, ensuring regulatory requirements are met and post adjustment impact reporting. This can often include hundreds or even thousands of claims at a time, and so careful coordination with other departments is essential. The Claims Data Specialist will also review updates made to provider records to identify the adjustments needed.
  
  

  QUALIFICATIONS:

  • Associates degree or two (2) years of equivalent experience required.
  • Minimum of two (2) years’ experience that includes two or more of the following responsibilities is required: claims processing, claims customer service experience, healthcare/insurance programs, policy/procedure interpretation and application.
  • Experience reading and/or working with various types of medical claims preferred.
  • Excellent organizational, planning, problem solving, and decision-making skills.
  • Demonstrated ability to successfully apply problem solving and time management methodology and balance multiple tasks as business needs arise required.
  • Effective verbal and written communication & presentation skills are required. Must be able to communicate with technical and non-technical audiences.
  • Experience working with Word and Excel required.
  • Ability to validate expected outcomes.
  • Ability to think creatively and “outside of the box.”
  • Ability to learn and understand healthcare benefits, pricing, and provider data.
  • Ability to work independently as well as in a team setting is required.
  • Able to work in a fast paced and deadline-driven environment.
  • Demonstrated ability to identify weaknesses in workflow and recommend process improvements to continually ensure that corporate goals are satisfied.

  
  CDPHP salary ranges are designed to be competitive with room for professional and financial growth. Individual compensation is based on several factors unique to each candidate, such as work experience, qualifications, and skills. In addition to cash compensation, CDPHP employees may be eligible for an incentive payment, a discretionary cash reward based on employee and company performance. Some roles may also be eligible for overtime pay.
  
  CDPHP compensation packages go far beyond just salary. The company offers a comprehensive total rewards package that includes award-winning health care coverage, health care dollars, a generous paid time off allowance, employee assistance programs, flexible work environment, and much more. Learn about all CDPHP employee benefits at https://www.cdphp.com/about-us/jobs/benefits.
  
  As an Equal Opportunity / Affirmative Action Employer, CDPHP will not discriminate in its employment practices on the basis of race, color, creed, religion, sex (including pregnancy, childbirth, or related medical conditions), sexual orientation, gender identity or expression, transgender status, age, national origin, marital status, citizenship, disability, criminal record, genetic information, predisposition or carrier status, status with respect to receiving public assistance, domestic violence victim status, protected veterans status, or any other characteristics protected under applicable law. To that end, all qualified applicants will receive consideration for employment without regard to any such protected status.
  
  CDPHP and its family of companies include subsidiaries Strategic Solutions Management Consultants (SSMC), Practice Support Services (PSS), and ConnectRx Services, LLC.

• About the company

  An award-winning, not-for-profit, physician-founded and guided health plan based in Albany, NY.

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