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Associate, Claims Examiner

Rochester Office, Rochester, New York, United States of America Req #224
Friday, August 2, 2019
Be a part of the transformation at MVP Health Care®. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people  with diverse backgrounds and experience—tech people, numbers people, even people people—to make health insurance more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.

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. Reports same to Claims Operations Leader. Keeps abreast of all benefit changes. Provides ongoing feedback to the senior or Claims Operations Leader to ensure all appropriate personnel are kept informed. Performs other duties as assigned.

POSITION QUALIFICATIONS

Minimum Education:
High School Diploma required. Associates in Health, Business, or related field preferred.


Minimum Experience:
Previous related health care experience required. Health insurance experience preferred. Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred.

Required Skills:
• Strong communication skills • Organizational skills and attention to detail; • Strong PC skills required, Microsoft Windows experience highly desired

MVP Health Care is an Affirmative Action/Equal Opportunity Employer (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), 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 hr@mvphealthcare.com.

Other details

  • Job Family Claims/Operations
  • Pay Type Hourly
  • Rochester Office, Rochester, New York, United States of America