Job Description
Job Description
Claims Specialist (Hybrid Remote) – $29/Hour | Bronx, NY | Full-Time | Temp to perm
Location: Bronx, NY (Hybrid Remote: 3 Days from Home, 2 Days On-Site)
Schedule: Monday–Friday | 8:30 AM – 5:30 PM (1-Hour Lunch)
Compensation: $29 per hour
Job Type: Full-Time | 40 Hours/Week | Temp to perm
Join a mission-driven healthcare organization in the Bronx as a Claims Specialist, where you’ll play a critical role in claims adjudication, provider relations, and payment configuration—all while benefiting from a hybrid work schedule and career stability in a growing industry.
If you’re experienced in healthcare insurance, claims processing, and provider contracting, this is your opportunity to take the next step in your career in a flexible, high-impact role.
Claims Specialist Key Responsibilities:
- Review and analyze medical claims adjudicated by third-party administrators (TPAs)
- Investigate and resolve provider appeals, disputes, returned or pended claims
- Conduct root cause analysis to recommend system or procedural improvements
- Validate DRG grouping, repricing, and provider compensation outcomes
- Create and test provider compensation grids to support accurate claims reimbursement
- Process and log returned checks/refunds to ensure timely credit of funds
- Compile reports on claim adjustments, payment discrepancies, and trends
- Communicate with internal teams, external vendors, providers, and regulatory contacts
- Assist in JOC meetings and provide guidance on billing and coverage policies
- Monitor claims processing workflows and recommend changes to improve accuracy and efficiency
- Ensure compliance with Medicaid/MLTC and managed care regulations
- Participate in performance tracking, SLA compliance, and ad-hoc projects
Claims Specialist Required Qualifications:
- Bachelor’s degree required
- Certified Professional Coder (CPC) is preferred
- 8+ years of insurance experience within a healthcare or managed care setting preferred
- Strong understanding of:
- Claims adjudication processes
- Medicaid/MLTC programs
- Provider contracting, CPT, ICD-9/ICD-10, HCPCS, DRG, Revenue, RBRVS
- Utilization management and authorizations
- Member/subscriber enrollment and billing systems
- Proficiency in Microsoft Excel, Word, PowerPoint, and claims processing/database systems
Why Join Us?
- Competitive hourly rate: $29/hour
- Hybrid schedule for improved work-life balance
- Career-building opportunity in healthcare administration and claims analysis
- Stability and growth in a well-established healthcare setting
This is more than a job—it’s a chance to grow your healthcare operations career while contributing to efficient, member-focused claims operations in New York City.
Apply today to bring your healthcare expertise into a role designed for flexibility, growth, and impact.
Company DescriptionAtlas Search is an executive recruiting firm dedicated to placing accounting, finance, middle office, information technology, human resources, and office / accounting support professionals. Our clients range from Fortune 500 to start-ups and we service all industries ranging from Financial Services to Media & Entertainment. We were founded on the principle of relationships; our firm has been built on partnering with candidates and clients with a focus on their long-term interests. We provide Technology professionals like yourself on a permanent basis for our clients across all industries. Specialties include: Software Engineers, Web Developers, iOS/Android Engineers, Data Analysts, Business Intelligence, Data Engineers, Data Scientists, Help Desk/Desktop Support, Systems Administrators/Engineers, Network Administrators/Engineers, Cloud/DevOps Engineers, Application Support, Business Analysts, Project Managers, IT Managers, CTOs, etc.
Company Description
Atlas Search is an executive recruiting firm dedicated to placing accounting, finance, middle office, information technology, human resources, and office / accounting support professionals. Our clients range from Fortune 500 to start-ups and we service all industries ranging from Financial Services to Media & Entertainment. We were founded on the principle of relationships; our firm has been built on partnering with candidates and clients with a focus on their long-term interests. We provide Technology professionals like yourself on a permanent basis for our clients across all industries. Specialties include: Software Engineers, Web Developers, iOS/Android Engineers, Data Analysts, Business Intelligence, Data Engineers, Data Scientists, Help Desk/Desktop Support, Systems Administrators/Engineers, Network Administrators/Engineers, Cloud/DevOps Engineers, Application Support, Business Analysts, Project Managers, IT Managers, CTOs, etc.