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We are seeking a Claims Analyst for a well-known insurance company in the White Plains area. The ideal candidate will have hands-on Disability and Paid Family Leave (PFL) claims experience and 1–2 years of billing, coding, or claims experience.
This role focuses on reviewing, adjudicating, and processing health insurance claims with a strong emphasis on disability and PFL leaves, ensuring compliance with NYS regulations and company procedures.
Key Responsibilities:
Requirements:
Overview of Role:
This role involves reviewing and processing health insurance claims with a focus on Disability and PFL leaves. You will ensure claims meet all regulatory and company standards, investigate complex issues like coordination of benefits or pre-existing conditions, and communicate with claimants, employers, or healthcare providers as needed. Accurate record-keeping and clear member communications are key to success.
Claims Analyst - Disability/PFL leave
333 Westchester Ave White Plains, NY 10604 US
Posted: 11/07/2025
2025-11-07
2026-01-12
Employment Type:
Contract To Hire
Job Category: Administrative Support
Job Number: 10513
Pay Rate: 51,000
Job Description
We are seeking a Claims Analyst for a well-known insurance company in the White Plains area. The ideal candidate will have hands-on Disability and Paid Family Leave (PFL) claims experience and 1–2 years of billing, coding, or claims experience.
This role focuses on reviewing, adjudicating, and processing health insurance claims with a strong emphasis on disability and PFL leaves, ensuring compliance with NYS regulations and company procedures.
Key Responsibilities:
- Assist with incoming Disability, PFL, Critical Illness, and Accident claims, ensuring timely acknowledgment and processing.
- Determine the correct product and fund (DBL, self-funded, voluntary, PFL, Critical Illness, Accident) and verify eligibility.
- Apply knowledge of NYS DBL/PFL guidelines, self-funded plans, and voluntary policies to handle claims accurately.
- Make precise claim determinations, including disability/PFL periods, maximum periods, and other criteria for payment or denial.
Requirements:
- Hands-on experience with Disability and Paid Family Leave claims is required.
- Basic proficiency in Microsoft Word and Excel.
Overview of Role:
This role involves reviewing and processing health insurance claims with a focus on Disability and PFL leaves. You will ensure claims meet all regulatory and company standards, investigate complex issues like coordination of benefits or pre-existing conditions, and communicate with claimants, employers, or healthcare providers as needed. Accurate record-keeping and clear member communications are key to success.
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