Claims analyst jobs in Hicksville, New YorkCreate job alerts

Job Description This is an on-site position located in Roslyn, NY General Summary: The Clinical Risk Analyst works with the Underwriting Department and an EmPRO-employed physician to evaluate medical records, legal documents, and expert opinions in order to assess potential liability, risk exposure, and financial impact for current and prospective insured physicians. This role also develops data-driven analyses to identify medical and malpractice trends that may impart future risk to the Company. Important Note: This position offers meaningful opportunities to learn and grow. While prior experience is valued, EmPRO provides structured onboarding, ongoing training, and support to help candidates develop the knowledge and skills necessary to succeed. Essential Duties & Responsibilities: Responsibilities related to Underwriting Support & Policy Management: • Collaborate with the lead underwriter and EmPRO’s underwriting physician to evaluate policy renewals, focusing on high-risk accounts or those with a history of claims., • Develop and maintain underwriting guidelines as it pertains to risk assessment on new and renewal business., • Research and prepare files for potential remediation up to non-renewal of an insured’s policy, as well as physician teleconference meetings., • Attend non-renewal meetings and prepare summary post meeting analysis for underwriting management., • Assess conditional renewal cases, gathering additional information as needed to determine appropriate policy terms, conditions, and pricing., • Provide data and analysis to support decisions on non-renewals, clearly articulating the rationale based on risk factors and claims history., • Work hand in hand with Preverity to build and enhance work streams to ensure rate and risk adequacy on accounts. This would include improving automation and defining triggers for monitoring our insureds’ practice., • Defining research projects for the purpose of generating actionable knowledge to inform Underwriting of important data trends. Claims Evaluation: • Work in conjunction with the assigned underwriter and claims representative to review and analyze incoming professional liability claims., • Review medical records, legal documents, and expert opinions to determine the potential liability, perform risk assessment and financial exposure., • Prepare detailed claims summaries and present findings to the underwriting team and management for review and decision-making. Risk Analysis & Reporting: • Identify trends and patterns in claims data to inform underwriting guidelines and risk mitigation strategies., • Develop and maintain reports on key performance indicators (KPIs) related to claims frequency, severity, and underwriting performance., • Assist in the preparation of reports for senior management, providing insights into the overall health of the professional liability portfolio., • All other duties deemed appropriate by management. Education & Qualifications: • Openness to a new career direction; demonstrating a growth mindset and willingness to learn. Candidates will receive support thorough onboarding and in working with EmPRO’s underwriting physician. There are also opportunities for career development through EmPRO’s Educational Assistance Program., • Degree in any of the following areas is required: physician, physician assistant, nurse practitioner, insurance, risk management, healthcare administration, or nursing., • Advanced clinical degree or Legal Nurse Consultant certification is not required but would be viewed as a strong asset., • Minimum of 3 years with direct healthcare experience is required., • Minimum of 3 years of experience in professional liability insurance is highly preferred, with direct experience in claims analysis, underwriting, or a related field., • Proficiency in interpreting and analyzing medical and legal documents., • Experience with medical terminology and healthcare systems preferred., • Knowledge of state-specific insurance regulations and legal frameworks related to professional liability preferred., • Strong analytical and problem-solving skills with a keen attention to detail required., • Excellent written and verbal communication skills, with the ability to present complex information clearly and concisely., • Proficiency in data analysis and reporting tools (e.g., Microsoft Excel, claims management software). Analytic programming languages such as R are not required but would be viewed as an asset., • Ability to work independently and collaboratively in a fast-paced, deadline-driven environment., • Demonstrated ability to maintain confidentiality and handle sensitive information with discretion., • Capacity to work on short, intermediate, and long-range projects while also being able to meet tight deadlines., • Strong and deliberative planning skills, • Must be detail-oriented and have good organizational skills., • Ability to effectively communicate with others in a professional manner., • Ability to function in a professional office environment and utilize standard office equipment.

Job Description This role is onsite at our Roslyn, NY, Rochester, NY, or Hamilton, NJ office, with the option for a hybrid schedule after the training period. General Summary: A Senior Claims Analyst will investigate, evaluate, and resolve claims while ensuring compliance with regulatory and company policies. Essential Duties & Responsibilities: • Follow standard claims protocols for documentation, coverage investigations, and file management., • Maintain accurate and organized claims files., • Investigate and document incident particulars, setting appropriate indemnity and expense reserves, • Negotiate and bring to resolution directly and through defense attorneys, • Attend trials and mediations when necessary., • Adhere to industry Best Practices for effective claim management., • Expand skills through participation in training and professional development courses., • Ensure exceptional data integrity, • Proactive communication with insureds, other departments and claims leadership., • Bachelor’s degree or JD required, • Three years’ claims handling experience, • NY adjusters license required within the first 6 – 12 months of employment., • Strong analytical and problem-solving skills with attention to detail., • Proficient business writing and oral communication skills, • Ability to work independently as well as collaboratively within a team., • Strong ethical judgement and a commitment to maintaining confidentiality., • Must be able to work on site

Job DescriptionJob TitleSenior Claims Analyst, GL/ExcessLocationHybrid (Manchester, NH or Garden City, NY)SummaryReporting to the Unit Manager, this role will be responsible for direct handling of commercial claims specific to General Liability and/or Excess General Liability. Familiarity with SME (small to midsize enterprises) involving premises liability, including but not limited to lessor’s risks, franchisees, hotels, and restaurants/entertainment, and some contractors and serving risks. Duties include investigation and evaluation of coverage, liability, risk transfer (i.e. indemnification and/or tender application), and damages issues. The role will be responsible for claim and coverage evaluation, establishment/recommendation of adequate reserves, litigation management, liability and damage analysis in detail, case resolution and best claims outcome, and transaction processing in alignment with the Company’s and Client’s Strategic Vision. Essential Functions • Direct handle commercial and business general liability claims., • Mentors and guides less experienced claim analysts., • Assists the Unit Manager with departmental problem solving., • Manages external relationships including third party administrative oversight., • Serves on Companywide committees and projects as assigned., • Anticipates and identifies risks and opportunities on coverage and liability., • Anticipates and identifies transfer of risk, tender and/or indemnification., • Manage timely reporting of large losses and potential large loss exposures, coverage issues, time limit and policy limit demands, mediations, and pre-trial reports to Manager for distribution to internal and external clients, • Directly handles and/or assists in monitoring, reviewing, and coordinating the activities involving commercial and/or personal lines insurance claims, including analysis of coverage issues, establishment of adequate reserves, and the resolution and closure of claims., • Reviews loss notices; confirms and interprets policy coverages; establishes adequate reserves; and investigates and handles claims involving primary, umbrella, and/or excess policies., • Manages litigation with Preferred Counsel under Alternative Fee Arrangements or other defense fee structures., • Pursues and maximizes all risk transfer opportunities by contract or by insurance policy language., • Assigns and manages of work of defense counsel, assignment of expert witnesses and interfacing with peer carriers including design and execution of defense and indemnity contracts, evaluation of liability and damages and participation in settlement negations., • Ensures proper file setup, reserving, general handling, and application of company procedure., • Participates in developing claims handling strategy, including defense coordination, litigation strategy and budgets, and expense control., • Records specific claims information and reports as appropriate to a manager relative to pertinent financial and general statistical records., • Maintains diary control, investigates, analyzes, and reports to ensure maintenance of proper reserves to reflect the company’s exposure and reports to our Reinsurance Department to assist in providing notice to reinsurers and the Reinsurance Department’s recovery of specific amounts when payment exceeds the company’s retention.

General Summary: A Senior Claims Analyst will investigate, evaluate, and resolve claims while ensuring compliance with regulatory and company policies. Proactive communication with insureds, other departments and claims leadership. Three years' claims handling experience.

Job Description This is an on-site position located in Roslyn, NY General Summary: As a member of the IT development team, the Senior Business Systems Analyst is responsible for delivering technical implementation tasks for business operation, configures the software, builds, and tests the application(s). The Senior Business Systems Analyst is expected to document and to explain the implementation concepts to the technical and business teams. Essential Duties & Responsibilities: • Designs the software configuration to meet the business process design and application requirements., • Responsible for eliciting, analyzing, and documenting requirements and/or functional specifications as needed, including determination of system impact and software configuration., • Participate with business units and internal functions as appropriate throughout the development, testing, and implementation processes., • Research and evaluate alternative approaches and recommend efficient and cost-effective solutions., • Define business needs and elicit business requirements. Produce artifacts that accurately depict business needs for product implementation such as business requirements and process flow diagrams., • Prepare Test strategy/Test Plan and execute accordingly. Perform QA testing in configuration, software modifications, reports/dashboard and any 3rd party integration., • Works with other developers, designers, and architects to ensure the configuration and custom components meet application requirements and performance goals., • Understands the functional impact of various configuration options., • Performs other related duties and activities as required. Education & Qualifications: • Bachelor’s degree., • Minimum 8-10 years’ experience with Malpractice insurance or Property/Casualty Insurance., • Minimum of 3-5 years' experience as a Business Analyst Experience with SQL and other report writing tools., • Minimum 3 – 5 years’ policy administration/claims administration system implementation experience., • Extensive experience with software applications, including Microsoft Office - Word, PowerPoint, Excel., • Experience with implementation of Insurance software Platform a plus., • Origami Risk platform experience preferred., • Strong oral and written communication skills; ability to clearly interpret and relay information in a professional manner., • Strong ability to gather, organize, analyze and present data., • Strong organizational skills and ability to handle multiple tasks while meeting deadlines., • Proven record of complex problem solving and decision making. The actual compensation for this position will be determined by experience and other factors permitted by law.

Job Description This is an on-site position located in Roslyn, NY General Summary: A Claims Analyst Trainee will join an entry‑level program that provides structured training and hands‑on experience to prepare participants to review, investigate, and process insurance claims. Trainees learn claims procedures, systems, and regulations while developing analytical and decision‑making skills under supervision Important Note: The Claims Analyst Trainee role is a temporary-to-hire employment opportunity. During the three-month trial period, skills, performance, and compatibility with the organization will be evaluated. If both parties find the role suitable after this period, an offer may be extended for regular full-time employment. Essential Duties & Responsibilities: • Accept incoming calls and assist Insured (s) who are calling about a claim, incident or summons., • Obtain all pertinent information from Insured (s) regarding the service of legal papers and medical data involved, • Establish/maintain a claim file when appropriate for reported claims to include but not limited to; verify coverage before opening new file, obtain legal papers and/or medical records appropriate to claim, assign defense counsel,, • When appropriate send necessary documentation, prepare reinsurance report when appropriate and complete all necessary forms and documents neatly, legibly and thoroughly, • Maintain a diary for assigned files for follow up, • Complete all processes/procedures as outlined by the Claims Department in support of claims handling, • Report accurately and appropriately in compliance with all State and Federal requirements (medical coding and statuary requirements), • Review and analyze all monthly legal bills from assigned law firms, both hard copy and electronic, for compliance with Claims Department policy for the legal handling of claim files and legal billing guidelines, • Ensure that all hard copies from law firms are received and obtain any missing information from law firms, if necessary, • Maintain department standard turnaround time for processing invoices, • Prepare electronic check requisition for accounting, • Collaborate with Claims Analyst / Management on the review of legal and vendor invoices received from defense counsel, • Conduct billing audit within specified time frames to maintain timely payment of vendor fees, • Participate in claims conferences, mentoring meetings and trial observations, • Assigned projects (either individual or on a team) and complete projects by deadlines provided, • Ability to maintain high degree of confidentiality especially regarding information in files, • Adhere to timeline of training development program as outlined and approved by Claims Department, • All other duties deemed appropriate by management Education & Qualifications: • College graduate or progression toward a degree with related work experience in the following areas: Medical, Legal or Insurance field., • Demonstrate proficient knowledge of Microsoft Office Suite (Outlook, Word, Excel, PowerPoint), • Demonstrate ability to quickly learn and adapt to new software programs, • Excellent verbal skills with the ability to convey information clearly and professionally in a business setting, • Ability to maintain a cooperative, courteous, and professional relationship while interacting with other departments, employees, management and insureds; ability to communicate effectively with diplomacy and professionalism, • Strong business writing skills required, communicate clearly and professionally while ensuring communication aligns with company standards and branding, • Display strong problem-solving abilities, with the capacity to perform effectively under pressure and adapt to shifting priorities in a dynamic office environment, • Ability to work onsite in the Roslyn, NY office from 9:00am to 5:00pm, Monday – Friday, • Meticulous with strong time management, multitasking, and organizational skills, • Ability to function in a professional office environment and utilize standard office equipment, • Ability to multi-task and prioritize tasks and deadlines, • Ability to work independently or in a team atmosphere The actual compensation for this position will be determined by experience and other factors permitted by law.

Job Description We are seeking a EPIC Billing Analyst to become an integral part of our team! This position is for our Garden City location. An Epic Billing Analyst is a healthcare IT professional specializing in the Epic electronic health record (EHR) system, focusing specifically on billing and revenue cycle functions. Responsibilities: • System Configuration and Optimization: Configure and maintain Epic's Resolute Professional Billing or Hospital Billing module to manage charges, benefit engines, claims, and payment processors., • Workflow Analysis and Improvement: Analyze workflows, data collection, and report details to identify areas for improvement and implement application solutions., • Support and Troubleshooting: Act as a primary support contact for end-users, resolving application issues and providing technical assistance., • Implementation and Upgrades: Lead or participate in the implementation of new systems or features, support system upgrades, and ensure compliance with industry standards (e.g., ICD-10)., • Collaboration and Communication: Liaise between the IT department, billing office, finance, and other stakeholders to tailor systems to meet organizational needs., • Testing and Documentation: Design, build, test, and document system changes and workflows., • Reporting and Data Analysis: Develop and generate reports to extract and analyze healthcare data., • Training: Collaborate with trainers on application changes and new features to develop training materials and strategies., • System Configuration and Optimization: Configure and maintain Epic's Resolute Professional Billing or Hospital Billing module to manage charges, benefit engines, claims, and payment processors., • Workflow Analysis and Improvement: Analyze workflows, data collection, and report details to identify areas for improvement and implement application solutions., • Support and Troubleshooting: Act as a primary support contact for end-users, resolving application issues and providing technical assistance., • Implementation and Upgrades: Lead or participate in the implementation of new systems or features, support system upgrades, and ensure compliance with industry standards (e.g., ICD-10)., • Collaboration and Communication: Liaise between the IT department, billing office, finance, and other stakeholders to tailor systems to meet organizational needs., • Testing and Documentation: Design, build, test, and document system changes and workflows., • Reporting and Data Analysis: Develop and generate reports to extract and analyze healthcare data., • Training: Collaborate with trainers on application changes and new features to develop training materials and strategies., • On-Call Support: Participate in on-call rotations to provide support for a 24/7 production environment.

General Summary: A Claims Analyst Trainee will join an entry-level program that provides structured training and hands-on experience to prepare participants to review, investigate, and process insurance claims. Important Note: The Claims Analyst Trainee role is a temporary-to-hire employment opportu

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Process insurance claims and follow up with customers.

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Coordinate customer service requests including order entry, pricing, expediting, billing, order maintenance, credit and claims.

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