Company Statement
EmblemHealth is one of the nation’s largest not for profit health insurers, serving members across New York’s diverse communities with a full range of commercial and government-sponsored health plans for employers, individuals, and families. With a commitment to value-based care, EmblemHealth partners with top hospitals and doctors, including its own AdvantageCare Physicians, to deliver quality, affordable, convenient care. At over a dozen EmblemHealth Neighborhood Care locations, members and non-members alike have access to community-based health and wellness guidance and resources. For more information, visit emblemhealth.com.
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Benefits Coordination and Recovery Specialist
Qualifications
Education, Training, Licenses, Certifications
- Bachelor’s degree in healthcare administration or related field required; additional experience/specialized training may be considered in lieu of degree
Relevant Work Experience, Knowledge, Skills, and Abilities
- 3 – 5+ year of experience in health insurance claims, COB investigation, claims recovery, or payment integrity required
- Solid understanding of COB investigative methodologies, overpayment recovery processes, and denial resolution required
- Proficiency with claims processing systems such as Facets and related eligibility and enrollment platforms required
- Strong written and verbal communication skills with the ability to effectively partner with regulatory agencies and external insurers required
- Detail-oriented with a focus on operational accuracy, compliance integrity, and overpayment prevention required
- Ability to manage multiple complex cases simultaneously in a fast-paced environment required
- Strong analytic, decision‐making, and problem‐solving abilities required
- Strong investigative skills, with proven ability to gather and interpret Explanation of Benefits (EOB), including use of online payer portals, answer questions and resolve standard as well as complex issues with payments required
- Ability to follow policy, procedures, and regulations in the workplace, and demonstrates ability to lead by example and support development of junior team members required
- Ability to effectively perform work independently and work cooperatively with others to promote a positive team environment required
- Proficient with MS Office (Word, Excel, PowerPoint, Outlook, Teams, SharePoint, etc.) required
Security Disclosure
If you receive a job offer from EmblemHealth, the email will be from “HRTalentAcquisition” with the subject: “Offer of Employment for (job title) – Please respond online.” We will never ask you to join a Google Hangout, buy your own equipment, or pay to apply. We also do not use third-party email services like Yahoo or Gmail.
Pay Disclosure
At EmblemHealth, we prioritize transparency in our compensation practices. We provide a good faith estimate of the salary range for potential hires, which is based on key factors such as role responsibilities, candidate experience, education and training, internal equity, and market conditions. Please be aware that this estimate doesn’t account for geographic differences related to your work location. Typically, new hires may not start at the top of this range, as compensation is tailored to each individual's circumstances. For union positions, salaries will be determined according to the collective bargaining agreement. Join us at EmblemHealth, where your contributions are valued and supported by fair compensation.
EEOC Statement
We value the diverse backgrounds, perspectives, and experiences of our workforce. As an equal opportunity employer, we consider all qualified applicants for employment regardless of race, color, religion, sex, sexual orientation, age, creed, citizenship status, gender identity, pregnancy, marital status, national origin, disability, veteran status, or any other protected characteristic protected by law.
Sponsorship Statement
At EmblemHealth, we are committed to building a diverse and talented workforce. However, we are unable to consider applicants who require, or are likely to require, either before or after hire, visa sponsorship for work authorization in the United States, including but not limited to H-1B, F-1 (STEM OPT), TN, or any other non-immigrant status. Some extremely rare exceptions may apply based on critical business needs.