Associate, Claims Examiner

Associate, Claims Examiner

Headquarters Office, 625 State Street, Schenectady, New York, United States of America

Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America Req #2230

Wednesday, October 16, 2024

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement.

To achieve this, we're looking for a Claims Examiner to join #TeamMVP. If you have a passion for medical claims and attention to detail this is the opportunity for you.

Full-Time, Non-Exempt

What's in it for you :

• Growth opportunities to uplevel your career
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
• Competitive compensation and comprehensive benefits focused on well-being
• An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work for and one of the Best Companies to Work For in New York

Qualifications you'll bring :

• High School Diploma required. Associate degree in health, Business or related field preferred
• The availability to work Full-Time, Virtual within New York State
• Previous related health care experience required
• Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred.
• Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail.
• Curiosity to foster innovation and pave the way for growth
• Humility to play as a team
• Commitment to being the difference for our customers in every interaction

Your key responsibilities :

• Using a PC / Microsoft Window environment, adjudicates claims with the aid of the Facets and Macess Systems.
• Reviews and ensures the accuracy of all provider, member and claim line information for all claims for which the examiner is responsible.
• Knowledge of Facets and Macess systems strongly preferred, but not required.
• Reviews and ensures the accuracy of all changes to claim line information based on information received from other departments and in accord with available benefit information.
• Is responsible for the timely and accurate adjudication of claims that are suspended to other MVP departments for benefit and / or authorization determination.
• Meets or exceeds department quality and work management standards for claims adjudication.
• Successfully completes a course of comprehensive formal training in all areas of benefits determination, system navigation, and MVP policy.
• Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on criteria set by those departments.
• Handles inquiries regarding suspended claims from other departments and identifies trends in suspensions based on these inquiries and other feedback.
• Keeps abreast of all benefit changes.
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Where you'll be :

Virtual within New York State

Pay Transparency

At MVP, we are committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting.

Specific employment offers and associated compensation will be made individually based on several factors, including but not limited to geographic location;

relevant experience, education, and training; and the nature of and demand for the role.

Affirmative Action

MVP is an Affirmative Action / Equal Employment Opportunity (PDF). We recruit, employ, train, compensate, and promote without regard to race, religion, creed, color, national origin, age, gender, sexual orientation, marital status, disability, genetic information, veteran status, or any other basis, e.

g., Pay Transparency (PDF), and the Know your Rights protected by applicable federal, state or local law. Any person with a disability needing special accommodations to the application process, please contact Human Resources at [email protected] .

Other details

• Job Family Claims / Operations
• Pay Type Hourly
• Min Hiring Rate $20.00
• Max Hiring Rate $23.00

Apply Now

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Headquarters Office, 625 State Street, Schenectady, New York, United States of America

Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America

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