Healthcare Claims - Reimbursement Specialist

The Reimbursement Specialist is responsible for analyzing weekly, monthly and quarterly post implementation claims reports. He/she owns project goals such as: developing project plans, establishing deadlines, monitoring milestone completion, and providing timely reporting of issues that impact progress and conflict resolution. This role involves testing, result verification, documenting and prioritizing assignments. The Specialist will work cross-functionally and interact with all levels of Management with little direction.

Duties & Responsibilities Include:

  • Create and update task plans as needed
  • Create and maintain dashboards for Medical Cost Saving initiatives and vendor savings
  • Conduct testing (including results verification) before sign-off and Production
  • Maintain accurate documentation on all processes and projects
  • Understand project concepts, objectives and approach
  • Complete assigned tasks and/or oversee the completion of those tasks within project timelines
  • Comply with HIPAA guidelines and maintain confidentiality of member, provider, medical and departmental information. Adhere to state and federal compliance and regulatory guidelines.
  • Complete other projects and additional duties as assigned

Minimum Qualifications:
  • High School Diploma or GED from an accredited institution
  • Experience working in Microsoft Outlook, Word, PowerPoint and Excel
  • Proficient experience with MS Excel functions that include working with large data sets, creating standardized reports (across multiple spreadsheets), utilizing vLookups and advanced functions/formulas; creating, using and interpreting pivot tables, filtering and formatting

Preferred Qualifications:
  • Associate degree or higher
  • Ability and willingness to handle increasing workload and responsibility
  • Work experience in health insurance or healthcare environment
  • Experience with the investigation, determination and reporting of claims processes
  • Knowledgeable with Microsoft Office applications to include Word, Excel, PowerPoint, Outlook
  • Some knowledge of SQL/VBA/T-SQL/SAS programming languages
  • Experienced with working with difference groups, knowledge gathering requirements, etc.

Compliance & Regulatory Responsibilities: See Above

License/Certification: NA

WE ARE AN EQUAL OPPORTUNITY EMPLOYER. Applicants and employees are considered for positions and are evaluated without regard to mental or physical disability, race, color, religion, gender, national origin, age, genetic information, military or veteran status, sexual orientation, marital status or any other protected Federal, State/Province or Local status unrelated to the performance of the work involved.

If you have a disability under the Americans with Disability Act or a similar law, and want a reasonable accommodation to assist with your job search or application for employment, please contact us by sending an email to or calling 212-519-1798 . In your email please include a description of the accommodation you are requesting and a description of the position for which you are applying. Only reasonable accommodation requests related to applying for a position within Healthfirst Management Services will be reviewed at the e-mail address and phone number supplied. Thank you for considering a career with Healthfirst Management Services.

EEO Law Poster and Supplement

Back to top