Commercial Claims Processing Associate, Senior Claims Examiner

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Job description

Commercial Claims Processing Associate, Senior 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

Thursday, October 24, 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 Sr. Claims Examiner to join . If you are a team player with a passion for health care and attention to detailthis is the opportunity for you.

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:

AAS degree with claims experience preferred, or equivalent combination of education and experience will be considered.

The availability to work Full-Time, Virtual within New York State

Two years' experience processing health insurance claims 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.

Ability to prioritize multiple assignments with attention to details and deadlines in a high-volume environment.

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:

Provides feedback to the unit leader concerning the daily activities of each unit, ensuring that each unit is running effectively, and handling of priority issues and claim projects in a timely manner.

Acts as point person for each unit, and is responsible for receiving and responding to E-mail, internal and corporate service forms, and phone inquiries from Member Services, Provider Relations, and all applicable regional offices.

Monitors and assists with the distribution of SF's, and E-mail correspondence for claim corrections to the claims examiners for processing.

Responsible for reporting functions on a daily, weekly and monthly schedule. These include: Calculating daily production goals for each unit; reviews aged claim reports to ensure claims do not reach specified age categories

Runs reports showing the daily production numbers of each examiner in the unit; Calculates and produces the weekly and monthly unit production reports; Reviews high priority reports, including claim adjudication; analyzes claims processing trends and issues and creates reports from Facets system selects and downloads when needed; and calculates and reports monthly miscellaneous time usage reports for each unit and line of business.

Responsible for specialized training of new and existing claims examiners, as well as forwarding and explaining new claim procedures, processes, and information to each examiner

Responsible for routine call coaching/question time with all applicable E-workers on the team, providing necessary feedback to the Supervisor of the team as needed.

Responsible for outbound calls/faxes to provider offices for our member submitted claims.

Reviews quality control on claims as well as appeals. Will work with Quality Assurance on any discrepancies on errors between the examiners and makes first line decisions regarding the outcome of appeals.

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, preferably close to an office location

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 (url removed) .

Other details
Job Family Claims/Operations

Pay Type Hourly

Min Hiring Rate $23.00

Max Hiring Rate $29.00

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