Claims Examiner

🔥 7 minutes ago

🗽 New York – Remote

🗽 New York – Remote

💵 $20 - $26 / hour

⏰ Full Time

🟢 Junior

🟡 Mid-level

📋 Claims Specialist

🚫👨‍🎓 No degree required

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MVP Health Care

WebsiteLinkedInAll Job Openings

1001 - 5000 employees

Founded 1983

⚕️ Healthcare Insurance

👥 B2C

🤝 B2B

Healthcare Insurance • B2C • B2B

MVP Health Care is a regional health insurer offering Medicare Advantage, Medicaid, individual and family plans, Child Health Plus, Essential Plans, and employer-sponsored group coverage. The company provides dental and vision add-on plans, prescription benefits, 24/7 virtual care through its Gia online portal, member services for billing and claims, and community wellness programs focused on affordable, accessible coverage in New York and nearby regions.

📋 Description

• 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. • 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.

🎯 Requirements

• High School Diploma required • Associate degree in health, Business or related field preferred • 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.

🏖️ Benefits

• 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 in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace.