Job Description

Commercial Claims, Senior Claims Examiner

Headquarters Office, 625 State Street, Schenectady, New York, United States of America Req #1585

Wednesday, July 12, 2023

Over 35 years strong and fueled by 1,700 smart, passionate employees across New York state and Vermont, MVP is full of opportunities to grow. We are a nationally recognized, award-winning leader for a reason. The beating heart of our company is a wide range of employees from a diverse set of backgrounds-tech people, numbers people, even people people-working together to make health insurance better. If you are ready to join a thriving, mission-driven company where you can create your own opportunities and make a positive difference-it\'s time to make a healthy career move to MVP!

Full-Time, Non-Exempt

Candidates must have 2 years experience processing medical claims

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. Works closely with the Operations Department Quality and Training Development Unit to ensure quality control standards are met, and to provide regular feedback to each examiner on the accuracy of their work. Reviews quality control appeals, and makes first line decisions regarding the outcome of appeals. Performs other duties as assigned.

POSITION QUALIFICATIONS

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

Minimum Experience: Two years\' experience processing health insurance claims required.

Required Skills: * Strong interpersonal skills.

• Strong written and verbal communication skills.
• Must meet or exceed work management and quality standards.
• Excellent organizational skills and attention to detail.
• Working familiarity with word processing and spreadsheet software
• Ability to work independently as well as be an effective team member.
• Ability to prioritize multiple assignments with attention to details and deadlines in a high volume environment.
• Frequently subjected to pressure/stress due to time demands

About MVP
MVP Health Care is a nationally recognized, not-for-profit health insurer caring for more than 700,000 members in New York and Vermont. Committed to the complete well-being of our members and the communities we serve, MVP makes health insurance more convenient, more supportive, and more personal. We are powered by the ideas and energy of more than 1,700 diverse, employees from all backgrounds, committed to having a positive impact on the health and wellness of everyone we serve. MVP Health Care 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 hr@mvphealthcare.com

Please apply and learn more - including how you may become a proud member of our team.

Other details

• Job Family Claims/Operations
• Pay Type Hourly

MVP Health Care