Claims Examiner

🕒 vor 9 Tagen

🗽 New York – Remote

🗽 New York – Remote

💵 $20 - $26 / Stunde

⏰ Vollzeit

🟢 Junior

🟡 Mittelstufe

📋 Schadensspezialist

🚫👨‍🎓 Kein Abschluss erforderlich

Jetzt Bewerben

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MVP Health Care

WebsiteLinkedInAlle Stellen

1001 - 5000 Mitarbeiter

Gegründet 1983

⚕️ Krankenversicherung

👥 B2C

🤝 B2B

Healthcare Insurance • B2C • B2B

MVP Health Care ist ein regionaler Krankenversicherer, der Medicare Advantage, Medicaid, individuelle und Familienversicherungen, Child Health Plus, Essential Plans und arbeitgeberfinanzierte Gruppenversicherungen anbietet. Das Unternehmen bietet zusätzliche Zahn- und Sehpläne, Rezeptvorteile, 24/7-Online-Betreuung über das Gia-Portal, Mitgliederdienste für Abrechnungen und Ansprüche sowie Gemeinschaftsgesundheitsprogramme, die auf erschwingliche und zugängliche Versicherungen in New York und den angrenzenden Regionen ausgerichtet sind.

Beschreibung

• 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.

🎯 Anforderungen

• 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.

🏖️ Vorteile

• 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.