This position is responsible for multiple operational functions across the Member Services department, including the intake and analysis of membership enrollment and certification. Responsibilities include: • Data management across multiple data management systems (including claims processing system, case management systems, and databases) • Handling PII and PHI in adherence with HIPAA and federal data privacy regulations • Communication with multiple business teams internally (Claims, Certification, Enrollment, Outreach) and the public. • Maintaining subject matter expertise in the federal regulations that define the parameters of the World Trade Center (WTC) Health Program, which define Program eligibilities • Daily processing of diverse work products in a high volume environment, maintaining the highest standards of customer service. • Managing in-bound and out-bound calls, working with the public, and • Identifying issues quickly and escalating them through the management chain as needed.

Duties for the Healthcare Claims Processor include: - Resolving pended healthcare claims, prior approval requests and responding to providers. Analyzing claims to determine whether or not the claims should be approved or denied for payment. - Reviewing and addressing provider inquiries regarding claim adjudication - Meeting all required metrics for the position - Applying knowledge of medical coding and various medical claims forms to the claims process.