Job Title: Data Quality Analyst / Claims Service Correspondent
Location: New York, NY 10004
Duration: 04/27/2026 – 06/20/2026
Shift: 9:00 AM – 5:00 PM
Schedule: 5 days/week, 7 hrs/day, 35 hrs/week, No on-call
Schedule Notes: Candidate requirements: Work Schedule: Full time; Hours Per Week: 35; Days: Monday, Tuesday, Wednesday, Thursday, Friday; Shift time: 9am – 5pm; Work location: Hybrid; Patient Facing: No; Position Overview: This position is responsible for the accurate and timely response to written claim inquiries received from providers. Incumbent provides support regarding the adjudication and adjustment of claims for the multiple lines of business. The incumbent works closely with Provider Relations, Medical Management, Member Services and the Claims Processing unit; Scope of Role & Responsibilities: Act as a key liaison and service representative for all written provider inquiries and problem resolution; Respond to all claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators; Coordinate and track appropriate problem resolution activities with plan personnel in other departments (i.e., claims, utilization management); Manage and ensure appropriate follow-up and closure for all inquiries; Respond to Provider Inquiries in writing; maintain accurate files; Data Entry into the IMAX system; Perform claim adjustments to correct erroneous payments (overpayments/underpayments); Participate in Special Projects involving Claim Status Investigations; Resolve Member Bills referred from Member Services; Required Education, Training & Professional Experience: In-depth knowledge of MetroPlus Claims Processing protocols and payment schemes; Thorough knowledge of Plan Benefits; Proficiency in IMAX and TXEN; Customer Service Experience a plus; Must be able to handle irate providers in a professional manner; Excellent written/verbal communication skills
Work Setting: Managed Care / Health Plan
Pay Range: $60-$65/hr.

Requirements
Required Skills & Experience:

• In-depth knowledge of MetroPlus Claims Processing protocols and payment schemes
• Thorough knowledge of Plan Benefits
• Proficiency in IMAX and TXEN
• High volume inquiries experience
• Claims adjustment / claim adjuster experience
• Strong customer service skills
• Problem solving and follow-up management skills
• Issue resolution
• Ability to handle irate providers professionally
• Excellent written and verbal communication skills
• Data entry experience and maintaining accurate files
• Experience responding to provider inquiries including physicians, clinical staff, and administrators
• Experience coordinating with internal departments including claims and utilization management
• Experience performing claim adjustments for overpayments and underpayments

Education
QUALIFICATIONS FOR THE JOB:

• NYC Residency Preferred

EDUCATIONAL LEVEL:

• A Master’s degree in Public or Business Administration or in an equivalent or equally acceptable program and four (4) years of experience in a major governmental agency or large corporation or foundation in management analysis or in operational direction, planning, coordination or control of which, two years must have been in a supervisory, administrative or consultative capacity; OR
• Bachelor’s degree from an accredited college or university and five (5) years of experience as described above, of which three (3) years must have been in a supervisory, administrative or consultative capacity; OR
• A satisfactory equivalent combination of training, education and/or experience

Certifications & Licensure

• None

Job Summary
This position is responsible for the accurate and timely response to written claim inquiries received from providers and provides support regarding the adjudication and adjustment of claims for multiple lines of business. Works closely with Provider Relations, Medical Management, Member Services, and Claims Processing units.

Job Responsibilities

• Act as a key liaison and service representative for all written provider inquiries and problem resolution
• Respond to all claim inquiries from provider site personnel including physicians, clinical staff, and site administrators
• Coordinate and track appropriate problem resolution activities with internal departments
• Manage and ensure follow-up and closure for all inquiries
• Respond to provider inquiries in writing and maintain accurate files
• Perform data entry into IMAX system
• Perform claim adjustments to correct erroneous payments (overpayments/underpayments)
• Participate in special projects involving claim status investigations
• Resolve member bills referred from Member Services