Job Title: Procurement Specialist

Job Description

The Claims Specialist will support department operations related to provider communication, pended claim review, reporting, auditing, and oversight activities to ensure compliance with all applicable State, Federal, and contractual guidelines.

Responsibilities

• Review and investigate claims to be adjudicated by the TPA, including the application of contractual provisions in accordance with provider contracts and authorizations.
• Compile claim reports for adjustments resulting from external providers, vendors, and internal inquiries in a timely manner.
• Investigate suspense conditions to determine if system or procedural changes would enhance claim workflow.
• Communicate and follow up with a variety of internal and external sources, including providers, members, attorneys, regulatory agencies, and other carriers on claim-related matters.
• Analyze patient and medical information to identify COB, Worker's Compensation, No-Fault, and Subrogation conditions.

Essential Skills

• Experience in claims processing, data entry, and insurance.
• Proficiency in medical billing and claims analysis.
• Proficient in Microsoft Office, including Excel, Word, and PowerPoint.
• Experience in medical claims processing and healthcare customer service.
• Knowledge of MLTC/Medicaid/Medicaid benefits and Utilization Authorizations.

Additional Skills & Qualifications

• Certified Professional Coder (a plus).
• Experience within healthcare or managed care setting preferred.
• Knowledge of CPTs, ICD 9/ICD 10, HCPC, DRG, Revenue, and RBRVS.
• Experience using a claims processing system or comparable database software.

Work Environment

This is a hybrid position with a schedule of Monday-Friday from 8:30 am to 5:30 pm, including a one-hour lunch break. Work is required in the office on Wednesdays and Fridays. The role offers union benefits upon conversion to a permanent position.

Pay and Benefits

The pay range for this position is $20.00 - $25.00/hr.

Eligibility requirements apply to some benefits and may depend on your job

classification and length of employment. Benefits are subject to change and may be

subject to specific elections, plan, or program terms. If eligible, the benefits

available for this temporary role may include the following:

• Medical, dental & vision
• Critical Illness, Accident, and Hospital
• 401(k) Retirement Plan – Pre-tax and Roth post-tax contributions available
• Life Insurance (Voluntary Life & AD&D for the employee and dependents)
• Short and long-term disability
• Health Spending Account (HSA)
• Transportation benefits
• Employee Assistance Program
• Time Off/Leave (PTO, Vacation or Sick Leave)

Workplace Type

This is a hybrid position in Bronx,NY.

Application Deadline

This position is anticipated to close on Jun 20, 2025.

About Actalent

Actalent is a global leader in engineering and sciences services and talent solutions. We help visionary companies advance their engineering and science initiatives through access to specialized experts who drive scale, innovation and speed to market. With a network of almost 30,000 consultants and more than 4,500 clients across the U.S., Canada, Asia and Europe, Actalent serves many of the Fortune 500.

The company is an equal opportunity employer and will consider all applications without regard to race, sex, age, color, religion, national origin, veteran status, disability, sexual orientation, gender identity, genetic information or any characteristic protected by law.

If you would like to request a reasonable accommodation, such as the modification or adjustment of the job application process or interviewing due to a disability, please email actalentaccommodation@actalentservices.com for other accommodation options.