ZipRecruiter

Log In

1

Metroplus Jobs (NOW HIRING)

NYC Health Hospitals

Claims Quality Analyst

New York, NY · On-site

$55K - $65K/yr

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not ...

MetroPlusHealth

Foster Care Liaison

Manhattan, NY · Hybrid

$85K - $99K/yr

Unite. Care. MetroPlus Health 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 ...

MetroPlusHealth

Claims Quality Analyst

Manhattan, NY · On-site

$55K - $65K/yr

About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of ...

MetroPlusHealth

Care Manager

Manhattan, NY · Hybrid

$112K/yr

About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of ...

MetroPlusHealth

Call Center Representative I

Manhattan, NY · On-site

$17 - $22/hr

About NYC Health + Hospitals MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of ...

MetroPlusHealth

Peer Specialist

Manhattan, NY

$56K/yr

MetroPlus Health provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not ...

MetroPlusHealth

Foster Care Liaison

Manhattan, NY · On-site

$85K - $99K/yr

Unite. Care. MetroPlus Health 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 ...

next page

Showing results 1-20

People also search for

All JobsMetroplus Jobs

Metroplus information

See salary details

$5

$20

$21

How much do metroplus jobs pay per hour?

As of Jun 7, 2026, the average hourly pay for metroplus in the United States is $20.83, according to ZipRecruiter salary data. Most workers in this role earn between $19.95 and $21.88 per hour, depending on experience, location, and employer.

What is a MetroPlus job?

A MetroPlus job typically refers to a position at MetroPlusHealth, a health insurance provider serving New York City residents. Jobs at MetroPlusHealth span various roles, including customer service, healthcare management, administration, and IT. Employees work to provide affordable, quality healthcare solutions to individuals, families, and businesses. Positions may require experience in healthcare, insurance, or customer support, depending on the role.

What are the key skills and qualifications needed to thrive in the Metroplus position, and why are they important?

To thrive at MetroPlus Health, professionals typically need a background in healthcare administration, insurance, or case management, often supported by a relevant degree or credential. Familiarity with health plan management systems, regulatory compliance tools, and electronic records is important in this environment. Excellent communication, problem-solving skills, and the ability to work collaboratively help team members excel. These competencies are crucial for ensuring quality service delivery, regulatory compliance, and efficient support for members and providers.

What are some common challenges faced by employees at MetroPlus Health, and how are they addressed?

At MetroPlus Health, employees often navigate challenges such as managing a high volume of member inquiries, adhering to evolving healthcare regulations, and ensuring accurate coordination among providers, members, and internal teams. The organization provides robust training, cross-functional support, and up-to-date resources to help team members stay informed and equipped to handle these demands. Colleagues work collaboratively to share expertise and resolve complex cases, and management fosters a culture of continuous improvement and open communication. This supportive environment helps employees grow professionally while maintaining high standards of service and care.

More about Metroplus jobs
What cities are hiring for Metroplus jobs? Cities with the most Metroplus job openings:
What are the most commonly searched types of Metroplus jobs? The most popular types of Metroplus jobs are:
What job categories do people searching Metroplus jobs look for? The top searched job categories for Metroplus jobs are:
Metroplus jobs near you
Infographic showing various Metroplus job openings in the United States as of May 2026, with employment types broken down into 96% Full Time, and 4% Part Time. Highlights an 87% Physical, and 13% Hybrid job distribution, with an average salary of $43,327 per year, or $20.8 per hour.
Claims Quality Analyst

Claims Quality Analyst

NYC Health Hospitals

New York, NY • On-site

$55K - $65K/yr

Full-time

Medical, Retirement, PTO

Posted 21 days ago

NYC Health + Hospitals rating

7.9

Company rating: 7.9 out of 10

Based on 62 frontline employees who took The Breakroom Quiz

103rd of 869 rated healthcare providers

Job description

MetroPlusHealth provides the highest quality healthcare services to residents of Bronx, Brooklyn, Manhattan, Queens and Staten Island through a comprehensive list of products, including, but not limited to, New York State Medicaid Managed Care, Medicare, Child Health Plus, Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc. As a wholly-owned subsidiary of NYC Health + Hospitals, the largest public health system in the United States, MetroPlusHealth's network includes over 27,000 primary care providers, specialists and participating clinics. For more than 40 years, MetroPlusHealth has been committed to building strong relationships with its members and providers.
Position Overview
The Claims Quality Analyst is responsible for reviewing claims to determine if payments have been made correctly. This position analyzes data used in settling claims to determine the validity of payment of claims and reports overpayments, underpayments and other irregularities based upon benefit configuration, compliance with provider contract agreements, and Federal, State and Plan's established guidelines and/or policies and procedures. The incumbent will research, review, and suggest process improvements, training opportunities and is a resource of information to all staff. The incumbent will also perform special projects.
Work Shifts
9:00 A.M - 5:00 P.M
Duties & Responsibilities
  • Audit daily processed claims through random selection based on set criteria.
  • Document, track, and trend findings per organizational guidelines
  • Based upon trends, determine ongoing Claims Examiner training needs, and assist in the development of training curriculum.
  • Conduct in-depth research of contract issues, system-related problems, claims processing Policies and Procedures, etc., to confirm cause of trends. Recommend actions/resolutions.
  • Work with other organizational departments to develop corrective action plans to improve accuracy of the claims adjudication processes and assure compliance with organizational
    requirements and applicable regulations
  • Assist in the development of Claims policies and procedures
  • Provide backup for other trainers within
    the department
  • Assist in training of new departmental staffs
  • Assist with the research and resolution of audit appeal
  • Asist with external/internal regulatory audits
  • Identify policies or common errors requiring retraining sessions.
  • Participate in quality projects as required.
  • Collect, analyze data, identify trends, write reports (i.e., the monthly and quarterly reports) and present findings to the appropriate claims service management personnel.
  • Other duties as assigned by senior management

Minimum Qualifications
  • Associate degree required; Bachelor's degree preferred
  • Minimum of 4 years of experience performing claims quality audits in a NYS-based managed care setting
  • Expertise in both professional and institutional claims coding, and coding rules required.
  • Definitive understanding of provider and health plan contracting, delineation of risk, medical terminology and standard industry reimbursement methodologies required.
  • Strong knowledge of CMS Medicare and NYS regulations required.
  • Experience in training development and presentation preferred

Professional Competencies
  • Strong organizational, analytical, and oral/written communication skills required.
  • Proficiency in PC application skills, e.g., excel, word, PowerPoint, etc.,
  • Must be able to follow direction and perform independently according to departmental
  • Integrity and Trust
  • Must have excellent interpersonal, verbal, and written communication skills

#LI-Hybrid
#MHP50
Benefits
NYC Health and Hospitals offers a competitive benefits package that includes:
  • Comprehensive Health Benefits for employees hired to work 20+ hrs. per week
  • Retirement Savings and Pension Plans
  • Paid Holidays and Vacation in accordance with employees' Collectively bargained contracts
  • Loan Forgiveness Programs for eligible employees
  • College tuition discounts and professional development opportunities
  • College Savings Program
  • Union Benefits for eligible titles
  • Multiple employee discounts programs
  • Commuter Benefits Programs

What NYC Health + Hospitals employees say

Pay

Benefits

Hours and flexibility

Workplace

Get the full story on Breakroom

Apply