Job Title: Claims Adjustment Specialist I
Department: Executive Administration
Location: New York, NY 10004 (Hybrid)
Start Date: August 3, 2026
End Date: September 26, 2026
Positions: 3
Schedule: Monday–Friday | 9:00 AM – 5:00 PM | 35 Hours/Week | Hybrid
Pay range – $25/hr – $28/hr.
Summary
is committed to empowering New Yorkers by uniting communities through care. We believe that Health care is a right, not a privilege. If you have compassion and a collaborative spirit, work with us. You can come to work being proud of what you do every day.
As a Claims Adjustment Specialist I, the incumbent will be responsible for analyzing standard to complex post-paid healthcare claims that require in depth research to determine accuracy and/or mitigate payment errors.
The Claims Adjustment Specialist I is responsible for adjusting medical claims that result in over/underpayments due to claim processing system issues, contract/amendment updates, processing errors, or other issues. This position will be responsible for responding to inquiries from providers whose claims may be paid incorrectly and performing accurate data input and maintaining accurate records and files.
Product of Role & Responsibilities

• Research and analyze medical claims adjustment requests along with related documentation to determine payment accuracy and adjust/adjudicate as needed using multiple systems and platforms.
• Ensure that the proper payment guidelines are applied to each claim by using the appropriate tools, processes, and procedures (e.g., claims processing P&P s, grievance procedures, state mandates, CMS/Medicare/Medicaid guidelines, benefit plans, etc.)
• Research claims that may have paid incorrectly and communicate findings for adjustment; Adjust claims based on findings (i.e., correct coding, rates of reimbursement, authorizations, contracted amounts etc.) ensuring that all relevant information is considered.
• Advise business partners of findings outcome if their input is needed to help fix the issue.
• Communicate through correspondence with providers regarding claim payment or additional required information in a clear and concise manner.
• Process the adjustment of claims in a timely manner, according to established timelines.
• Remain current with changes/updates in claims processing, as well as updates to coding systems.
• Maintain accurate records of all claims processed, including notes on actions taken.
• Generate reports on claim activity as requested.
• Respond to audits of claims processed.
• Able to work independently and exercise good judgment

Required Education, Training & Professional Experience

• Associate degree preferred. High School Degree or evidence of having passed a High School Equivalency Program required.
• Minimum 3 years of claims operations experience in a healthcare field, with knowledge of integrated claims processing required.
• Strong Analytical Skills
• Experience using a PC and claim adjudication system(s)
• Experience using Customer Relationship Management (CRM) software; SalesForce a plus
• Experience working with large data and spreadsheets; skilled in Excel and Word
• Excellent communication skills Knowledge of medical terminology, CPT, ICD-10, and Revenue Codes

Additional Qualification.

• Processing of Medical Claim Forms (HCFA, UB04)Knowledge of Medical TerminologyKnowledge of HIPPA Guidelines regarding Protected Health InformationData Entry of Provider Claim/Billing information
• Experience handling or familiarity with Medical Claim inquiries from provider sites personnel including physicians, clinical staff, and site administrators.

Professional Competencies

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