Top 254 Claims representative Jobs in Flushing Ny

Representative, Health Plan Provider Relations - Remote Must reside in NY
Molina Healthcare —New York, NY
- $19.84 - $46.42 an hour
- Full-time
- Remote
- Medical office experience
- Mid-level
- Travel
- Health insurance
Remote Customer Service/Sales Representative
Agent Alliance —Forest Hills, NY
- $65,000 - $70,000 a year
- Full-time
- Remote
- Entry level
- Paid training
- Health insurance
Quick Apply
Accounts Representative
NewYork-Presbyterian Hospital —Manhattan, NY
- $34.30 - $40.55 an hour
- Full-time
- Hybrid work
- Spanish
- Mid-level
- High school diploma or GED
3d
Expedited Appeals Specialist (Remote)
EmblemHealth —New York, NY
- $48,600 - $83,160 a year
- Weekends as needed
- Remote
- Microsoft Outlook
- Research
- Mid-level
Claims - Field Claims Representative
The Cincinnati Insurance Companies —Garden City, NY
- $68,400 - $108,000 a year
- Day shift
- Mid-level
- Driver's License
- Bachelor's degree
- Paid time off
- 401(k) matching
1d
Senior Personal Lines Account Manager
Allan M Block Agency —Tarrytown, NY
- $80,000 - $90,000 a year
- Full-time
- Hybrid work
- Mid-level
- High school diploma or GED
- In-person
- Paid training
- Health insurance
Quick Apply
10d
Bilingual Insurance Sales & Customer Service Representative
Daniella Smolanick Insurance Agency Inc —Bayside, NY
- $42,000 - $200,000 a year
- Full-time
- Bilingual
- Spanish
- Sales
- COVID-19 protective measures
- Paid holidays
Quick Apply
Billing and Collections Representative
Always Home Care —Brooklyn, NY
- $50,000 - $80,000 a year
- Full-time
- Management
- Research
- Mid-level
- Health insurance
- Dental insurance
Quick Apply
Insurance Account Representative
Paris V. Mastroddi, Inc —Yonkers, NY
- $47,000 - $57,000 a year
- Full-time
- Microsoft Outlook
- Office
- US work authorization
- Disability insurance
- Health insurance
Quick Apply
Construction Insurance Broker Account Executive
Confidential —Melville, NY
- From $100,000 a year
- Full-time
- Sales
- Mid-level
- Office
- Health insurance
- Dental insurance
Quick Apply
Entry-Level Sales Rep (Remote Work)
Agent Integration —New York, NY
- $60,000 - $65,000 a year
- Full-time
- Remote
- Entry level
- Paid training
- Dental insurance
Quick Apply
Insurance Follow-up Representative
Catholic Health —Melville, NY
- $24 - $31 an hour
- Remote
- Mid-level
- 3 years
- High school diploma or GED
- Health insurance
- Tuition reimbursement
Outside Property Claim Representative
The Travelers Companies, Inc. —New York, NY
- $67,000 - $110,600 a year
- Rotating shift
- Remote
- Mid-level
- Residential
- High school diploma or GED
- Wellness program
- Paid holidays
Telephone Representative II (Provider Relations)
1199SEIU Family of Funds —New York, NY
- $49,495.68 - $62,570.04 a year
- Full-time
- Research
- Mid-level
- High school diploma or GED
- Vision insurance
Call Center Representative I
MetroPlus Health Plan —New York, NY
- $48,791 a year
- Full-time
- Hybrid work
- Sales
- Research
- High school diploma or GED
Customer Relations Representative - State Farm Agent Team Member
Rey Polanco - State Farm Agent —New York, NY
- $60,000 - $70,000 a year
- Full-time
- Hybrid work
- Communication skills
- Entry level
- Health insurance
- 401(k)
Quick Apply
Patient Financial Services Representative
Cavya solutions —New York, NY
- $35 - $40 an hour
- Contract
- Spanish
- Customer service
- Mid-level
Quick Apply
Outside Property Associate Claim Representative
The Travelers Companies, Inc. —New York, NY
- $52,600 - $86,800 a year
- Remote
- Microsoft Excel
- Microsoft Outlook
- Mid-level
- Wellness program
- Paid holidays
2d
Property Claims Examiner
Brown & Brown —Garden City, NY
- $80,000 - $100,000 a year
- Full-time
- Computer literacy
- Mid-level
- Office
- Employee stock purchase plan
- Paid holidays
Customer Service Representative - State Farm Agent Team Member
Nadeem Moustafa - State Farm Agent —Queens, NY
- $45,000 - $65,000 a year
- Full-time
- Office
- Communication skills
- Entry level
- Health insurance
- Dental insurance
Quick Apply
10d

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Representative, Health Plan Provider Relations - Remote Must reside in NY

Molina Healthcare -
New York, NY

Apply Now

Job Details

Full-time
$19.84 - $46.42 an hour

Benefits

Health insurance

Qualifications

Customer communication
Managed care
Managed care organization experience
Medical office experience
Schedule management
Health insurance knowledge
Productivity software
Cross-functional collaboration
Cross-functional communication

Full Job Description

JOB DESCRIPTION Job Summary

Provides support for health plan provider relations activities. Supports network development, network adequacy and provider training and education. Serves as primary point of contact between the business and contracted providers within the Molina network. Responsible for network management including provider education, communication, satisfaction, issue intake, access/availability and ensuring knowledge of and compliance with Molina policies and procedures.

Essential Job Duties

Successfully engages high-volume, high-visibility plan providers, to ensure provider satisfaction, facilitate education on key Molina initiatives, and improve coordination and partnership between the health plan and contracted providers.
Serves as the primary point of contact between Molina health plan and the non-complex provider community that services Molina members, including but not limited to fee-for-service (FFS) and pay-for-performance (P4P) providers.
Collaborates directly with the plan’s external providers to educate, advocate and engage as valuable partners - ensuring knowledge of and compliance with Molina policies and procedures while achieving the highest level of customer service; effectively drives timely issue resolution, electronic medical record (EMR) connectivity, and provider portal adoption.
Conducts regular provider site visits within assigned region/service area; determines daily or weekly schedule, to meet or exceed the plan's monthly site visit goals. Proactively engages with the provider and staff to determine; for example, non-compliance with Molina policies/procedures or Centers for Medicare and Medicaid Services (CMS) guidelines/regulations, or to assess the non-clinical quality of customer service provided to Molina members.
Provides on-the-spot training and education as needed, including counseling providers diplomatically, while retaining a positive working relationship.
Independently troubleshoots provider problems as they arise, and takes initiative in preventing and resolving issues between the provider and the plan whenever possible. The types of questions, issues or problems that may emerge during visits are unpredictable and may range from simple to very complex or sensitive matters.
Initiates, coordinates and participates in problem-solving meetings between the provider and Molina stakeholders, including senior leadership and physicians (examples include: issues related to utilization management, pharmacy, quality of care, and correct coding).
Independently delivers training and presentations to assigned providers and their staff - answering questions that come up on behalf of the health plan; may also deliver training and presentations to larger groups, such as leaders and management of provider offices, including large multispecialty groups or health systems, executive level decision makers, association meetings, and joint operating committees (JOCs).
Performs an integral role in network management, by monitoring and enforcing company policies and procedures, while increasing provider effectiveness by educating and promoting participation in various Molina initiatives; examples of such initiatives include: administrative cost-effectiveness, member satisfaction - Consumer Assessment of Healthcare Providers and Systems (CAHPS), regulatory-related, Molina quality programs, and taking advantage of electronic solutions (electronic data interchange (EDI), EMR, provider portal, provider website, etc.).
May provide training and support to new and existing provider relations team members as appropriate.

will require to travel at least once a week subject to change.

Required Qualifications

At least 2 years of customer service, provider services, or claims experience in a managed care or medical office setting, or equivalent combination of relevant education and experience.
General understanding of the health care delivery system, including government-sponsored health plans.
Organizational skills and attention to detail.
Ability to manage multiple tasks and deadlines effectively.
Interpersonal skills, including ability to interface with providers and medical office staff.
Ability to work in a cross-functional highly matrixed organization.
Effective verbal and written communication skills.
Microsoft Office suite and applicable software programs proficiency.

Preferred Qualifications

Familiarity with various managed health care provider compensation methodologies, primarily across Medicaid and Medicare lines of business, including: fee-for service (FFS), capitation and various forms of risk, ASO, etc.
Experience delivering training and facilitating educational presentations.

To all current Molina employees: If you are interested in applying for this position, please apply through the Internal Job Board.

Molina Healthcare offers a competitive benefits and compensation package. Molina Healthcare is an Equal Opportunity Employer (EOE) M/F/D/V

Pay Range: $19.84 - $46.42 / HOURLY
*Actual compensation may vary from posting based on geographic location, work experience, education and/or skill level.

Apply Now

Refine Your Search

claims representative jobs in flushing ny

Representative, Health Plan Provider Relations - Remote Must reside in NY

Remote Customer Service/Sales Representative

Accounts Representative

Expedited Appeals Specialist (Remote)

Claims - Field Claims Representative

Senior Personal Lines Account Manager

Bilingual Insurance Sales & Customer Service Representative

Billing and Collections Representative

Insurance Account Representative

Construction Insurance Broker Account Executive

Entry-Level Sales Rep (Remote Work)

Insurance Follow-up Representative

Outside Property Claim Representative

Telephone Representative II (Provider Relations)

Call Center Representative I

Customer Relations Representative - State Farm Agent Team Member

Patient Financial Services Representative

Outside Property Associate Claim Representative

Property Claims Examiner

Customer Service Representative - State Farm Agent Team Member

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