Job Title: Customer Service Representative –
Location: New York, NY
Duration: 08/03/2026 – 09/26/2026
Shift: 9:00 AM-5:00 PM | 7.00 Hours/Day | 35.00 Hours/Week | Hybrid
Pay Range – $20/hr – $22/hr.

Note:

• Hybrid work location.
• Not a patient-facing role.
• Respond to written claim inquiries from providers.
• Coordinate with Provider Relations, Medical Management, Member Services, and Claims Processing.
• Perform claim adjustments for overpayments and underpayments.
• Data entry into the IMAX system.
• Participate in claim status investigations and special projects.
• Resolve member bills referred from Member Services.

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
Product 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 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.

Professional Competencies:

• Integrity and Trust
• Customer Focus
• Functional/Technical skills
• Written/Oral Communication