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Claims Specialist
Employment Type: Indefinite Contract
Location: Jericho, NY (Remote options available)
Schedule: Monday–Friday | 8:00 AM – 5:30 PM
Hours: 40 hours/week
Start Date: 05/31/2026
Pay Rate: • Onsite: $22–$28/hr • Remote: $22–$25/hr
About the Role
We are seeking detail-oriented and motivated Claims Specialists to support clinical review and appeal/dispute adjudication programs. This role is responsible for coordinating healthcare claims review activities, tracking case progress, communicating with stakeholders, and ensuring timely completion of deliverables.
Key Responsibilities • Serve as the primary point of contact for appeal and dispute adjudication programs • Coordinate communication between healthcare plans, providers, patients, and internal teams • Monitor appeal/dispute statuses and communications through client portals • Conduct initial eligibility reviews and escalate recommendations as appropriate • Track and assign cases using internal and commercial software systems • Review and distribute case documentation to coders, billers, nurses, physicians, and clinical teams • Monitor key performance indicators including quality, timeliness, and contract deliverables
Required Qualifications • Associate’s or Bachelor’s degree in: Healthcare, Business, Management, Digital Studies, or related field • Minimum 2 years of healthcare claims, or comparable experience • Experience using project management software and electronic documentation systems