Claims Specialist - 251247

Claims Specialist (Contract)

Location: New Yor (remote)

Duration: Contract 6 months with possible extension

Schedule: Full-time, Monday–Friday

Flexible shifts: 7:00 AM – 3:30 PM or 9:00 AM – 5:30 PM (EST)

Job Summary

The Claims Specialist will coordinate activities critical to the successful completion of clinical studies and review projects. This role supports appeal and dispute adjudication programs by monitoring requests, coordinating with clinical partners, managing provider and contractor interactions, tracking deliverables, and supporting cross-functional communication. The ideal candidate is highly organized, detail-oriented, and comfortable working in a fast-paced, deadline-driven environment.

Key Responsibilities

• Serve as the primary point of contact for appeal and dispute adjudication programs
• Liaise with healthcare plans, providers, patients, and clients to coordinate requests, correspondence, and case documentation
• Monitor appeal/dispute status and communications via client portals
• Conduct initial eligibility reviews and recommend appropriate courses of action to internal teams and leadership
• Track and assign cases using commercial and custom software applications
• Compile and distribute case documentation to billers, coders, nurses, physicians, clinicians, and key stakeholders
• Monitor and report on key performance indicators (KPIs), including timeliness, accuracy, quality standards, and contractual deadlines
• Identify workflow barriers, recommend process improvements, and implement approved solutions
• Present case and project updates during team huddles and scrums using an agile, iterative approach
• Schedule and facilitate team status meetings; document decisions, assigned tasks, and next steps
• Prepare billing invoices upon case completion and coordinate with Finance and Accounting to track payments
• Mentor and train new staff on processes and case progression
• Perform additional duties as assigned

Education & Experience Requirements

• Bachelor’s degree (or higher) in healthcare, business, management, digital studies, or a related field plus 2 years of collaborative project support experience
• OR
• Associate’s degree in a related field plus 3 years of collaborative project support experience

Qualifications

• Experience with collaborative project management software and electronic documentation systems
• Strong problem-solving skills and ability to work collaboratively with medical, analytical, and administrative teams
• Excellent written and verbal communication skills, including professional phone etiquette
• Ability to work independently with minimal supervision
• Flexible, innovative, and creative mindset with strong multitasking abilities
• Proven ability to meet deadlines in a time-sensitive environment