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Posted: Sunday, August 27, 2017 12:03 AM


Medical Claims Manager at Pointers, Cleaners & Caulkers Funds
Rego Park, NY 11374

About the Job

Medical Claims Manager

Organization: Pointers Cleaners & Caulkers Funds
Location: Queens, NY
Job Type: Full-Time
Job Description: Health & Welfare Fund Claims Manager

Manage, analyze, review and process medical claims with the highest level of performance and quality for participants in the plan, in accordance with the plan document, its rules and guidelines. Responds to plan participants, medical service and third party billing inquiries. Coordinates claims payment with Medicare or other insurers. Supervises and manages claims processing employees.


Supervise claims processing department
Provide member support with benefit/health insurance questions
Responsible for management and day-to-day operations of all member health benefits
Process benefit claims
Review claims and benefit requests for completeness
Verify accuracy of information and current eligibility under the plan document.
Compile information and documentation for the completion and verification of benefit claims.
Prepare, analyze, and adjust claims for payment of services under the plan document.
Prepare correspondence to members, dependents, service providers, Medicare and other parties to request information needed to process a claim.
Perform data entry and correction to ensure up-to-date system claim information.
Determine member eligibility and process terminations and reinstatements
Determine whether member has additional coverage and coordinate claims processing with other insurers as necessary.
Determine and calculate underpayments/overpayments, using plan rules and procedures, making corrections and adjustments.
Comply with all HIPAA regulations and process claims with the highest level of confidentiality.
Communicate with members, insurance companies, providers, Funds’ Counsel
Compile and handle special projects as needed.
Assist Member Services as needed.
Other duties as assigned.


At least 5 years of medical claims processing with Management experience is strongly preferred
Basic knowledge of medical terminology, medical billing procedures and codes, ERISA and COBRA
Basic knowledge of grammar, spelling, and simple math such as percentages and ratios
Ability to analyze physician reports and basic knowledge of human anatomy
Strong analytical, organizational, and time-management skills
Proficient in Microsoft Office
Associates degree preferred
Ability to work independently


Email Resume and Cover Letter to
Please note that this position must be filled quickly, your prompt response is appreciated.
Salary commensurate with experience, package includes health coverage and pension.

• Location: Queens, Rego Park

• Post ID: 120342823 queens is an interactive computer service that enables access by multiple users and should not be treated as the publisher or speaker of any information provided by another information content provider. © 2017