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1199SEIU Funds

Hospital Claims Processor V

New York, NY, NY, United States

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Job details

Posting language: English
Posted: Aug 24, 2026

Original job description

Responsibilities

Review hospital claims and determine action needed to resolve pended claims
Process and evaluate hospital claims manually or through claims work flow
Validate information entered in hospital claims module (QNXT); determine the process or work flow needed to resolve discrepancies
Finalize hospital claims by applying knowledge of eligibility, benefits, pre-authorization rules, contractual policy and operational procedures
Review, finalize and respond to call tracking tickets in a timely manner to provider inquires
Perform additional duties and special projects as assigned by management

Qualifications

High School Diploma or GED required, some College or Degree preferred
Minimum two (2) years experience entering and updating hospital or medical claims in a health insurance or benefits environment required
Basic keyboarding skills required
Strong knowledge of hospital claims, eligibility, benefits, and reauthorization rules; knowledge of health claims system (QNXT)
Good knowledge of International Classification of Diseases (ICD-9, ICD-10) and Current Procedural Terminology (CPT) codes
Demonstrated organizational, perform multiple priorities, and analytical skills with the ability to follow through on assignments
Able to work well independently and in a team environment
Ability to meet strict deadlines, work well under pressure and in a fast-paced environment
Must meet performance standards including attendance and punctuality