• Claims Review Representative

    Humana (Albany, NY)
    **Become a part of our caring community and help us put health first** The Claims Review Representative 3 makes appropriate claim decision based on ... procedures, contract provisions, and state and federal legislation. The Claims Review Representative 3...and state and federal legislation. The Claims Review Representative 3 performs advanced… more
    Humana (07/10/25)
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  • Senior Claims Specialist

    CRC Insurance Services, Inc. (NY)
    …Three years of Claims handling experience and commercial and multi-line knowledge 3 . Ability to critically review a claim file for relevant information, ... **Please review the following job description:** Analyzes and processes claims by gathering information and drawing conclusions. Acts as a liaison between… more
    CRC Insurance Services, Inc. (05/23/25)
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  • Lead Billing Representative

    St. Mary's Healthcare (Amsterdam, NY)
    …procedures to guide and educate insurance teams. . Collaborate with the Senior Claims Analyst to review issues, adjust workflows, and reduce unnecessary ... inform patients and/or practitioners of any non-authorized services. . Review , monitor and bill Episode of Care claims...High school diploma or GED required. Minimum of three ( 3 ) years relevant experience required. . Certified Revenue Cycle… more
    St. Mary's Healthcare (07/03/25)
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  • Warranty Claim Representative

    Latham, The Pool Company (Latham, NY)
    …difference? A little about the position: Job Summary The Warranty Claim Representative is responsible for the triage and administration for all claim/repair ... lifecycles (data entry, drafting correspondence, cross system searches), policy administration ( review of applicable warranties for coverage against case files), and… more
    Latham, The Pool Company (06/20/25)
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  • Dental Network Service Representative

    Highmark Health (Albany, NY)
    …position, product development, network options, strategic partnerships, utilization review , local/national client demographics and dentist distribution. Interpret ... added benefits. Meet with all identified practices in assigned territory to review practice financial and quality performance. + Perform effective on-site visits… more
    Highmark Health (06/27/25)
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  • Utilization Review Manager

    Phoenix House (Wainscott, NY)
    **Utilization Review Manager** **Job Details** **Job Location** East Hampton Residential - Wainscott, NY **Position Type** Full Time **Education Level** Graduate ... Category** Nonprofit - Social Services **Description** **SUMMARY** The Utilization Review (UR) Manager coordinates commercial, and Medicaid Managed Care benefits… more
    Phoenix House (06/25/25)
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  • Health Insurance Biller, Bureau of Revenue

    City of New York (New York, NY)
    …accuracy following CMS and other third-party insurance regulations. Monitor and review claims with outstanding collection balances. Prepare patient statements ... Communicate updated patient information with clinic teams to ensure transparency. Review all claims CPT/ICD-10/HCPCS, payment modifiers in billing financial… more
    City of New York (05/24/25)
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  • Eligibility Specialist

    City of New York (New York, NY)
    …the Supplemental Nutrition Assistance Program- Claims and Recovery (SNAP CR). - Review claims calculations and make determination of whether to re-budget, ... commit fraudulent acts against HRA as per SSL 348.2; 348. 3 BFI is recruiting for (1) one Eligibility Specialist...function as an Eligibility Worker, who will: - Receive review and maintain a caseload of 25 case per… more
    City of New York (05/14/25)
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  • Contractual Reviewer - Senior

    Independent Health (Buffalo, NY)
    review of Independent Health policies, contracts, clinical documentation, claims systems, pharmacy formularies, procedures and department directives is required. ... be responsible for providing an organized, timely and consistent review and investigation of provider and/or member complaints and/or...diploma or GED required. Associates degree preferred. + Three ( 3 ) years of experience in a member or provider… more
    Independent Health (06/30/25)
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  • Human Resource Adminsitrator

    Transdev (Wallkill, NY)
    …cycle changes into the human resources information system and time tracking system + Review and reconcile invoices received for HR and remit for approval + Maintain ... forms dealing with but not limited to employment & wage verifications, unemployment claims and WOTC + Point of contact for Corporate HR communication + Maintains… more
    Transdev (06/12/25)
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  • Account Service Consultant I/II (Buffalo/WNY…

    Excellus BlueCross BlueShield (Buffalo, NY)
    …new product lines, and working closely with Operations, Customer Care, Claims , and Finance/Underwriting departments to support group implementations and address ... to the sales division. + Post group renewal benefit review and validations. + Attends provided/necessary training to support...and improvement. + Attends meetings and/or trainings as a representative of the Account Service Team and shares the… more
    Excellus BlueCross BlueShield (06/24/25)
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  • Americas IFM Lead

    Cushman & Wakefield (New York, NY)
    …these contracts, responsible for periodic and ongoing performance and financial review , conducting RFP's, and assuring payments and invoicing match contract pricing. ... building tenants/occupants * Ensure facility management staff implements ongoing contract review programs to constantly assess client, tenant and occupant needs and… more
    Cushman & Wakefield (06/18/25)
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  • Group Processing Worker

    City of New York (New York, NY)
    …with all statutory, regulatory, and contractual standards. The Division of Financial Review and Processing (DFRP) is responsible for the initiation of adverse ... They act on behalf of the Bureau of Fraud Investigation, Liens and Recovery, Claims and Collections and the Assistance Reimbursement Unit. Their staff review more
    City of New York (04/19/25)
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  • Employee Insurance Examiner 2

    New York State Civil Service (Albany, NY)
    …Providing training to staff, assigning work/projects, and performing daily review of their assigned work.* Reviewing assigned staffs' attendance, telecommuting ... credit hours AND three years of full-time experience described in #1; Or 3 . sixty college semester credit hours AND two years of full-time experience described… more
    New York State Civil Service (06/26/25)
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  • HSSE Regional Specialist

    C&W Services (New York, NY)
    …and support for all EH&S activities, including implementation, monitoring, and review of C&W compliance/performance. **Job Description** [Please delete this section ... all logs and documentation associated with permits and regulatory requirements * Review accidents and incidents which occur in the area of responsibility and… more
    C&W Services (06/27/25)
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  • Administrative Specialist Trainee 1 - NY Helps

    New York State Civil Service (New York, NY)
    …1 level include but are not limited to: Administrative Assistant 1, Office Assistant 3 , Program Aide, Claims Services Representative Trainee 1; OR*A ... Process legal bills approved by NYSIF attorneys* Work with Audit & Review department to generate weekly/monthly bill rejection reports* Other tasks may be… more
    New York State Civil Service (06/26/25)
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  • Facilities Manager

    Cushman & Wakefield (New York, NY)
    …Performance Report, and other reports and documentation, as required * Prepare, review , and give initial approval and as needed all budgets, financial reports ... that tenants and vendors comply with insurance requirements and coordinate all claims , as required KEY COMPETENCIES 1. Communication Proficiency (oral and written)… more
    Cushman & Wakefield (06/25/25)
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