Claims Examiner – Complex Claims & Growth (Remote)

Capital District Physicians Health Plan Inc; City of Binghamton (NY); On-site; USD 28,000 - 46,000; Full time

Benefits offered by this job

Remote work possibility

Job summary

Capital District Physicians Health Plan Inc is seeking a Claims Examiner to resolve a wide range of claims transactions, including entry, adjudication or adjusting in accordance with MTM, NCQA and other mandated policies.

The role advances through Levels I–IV with increasing responsibility, requiring a high school diploma, claims processing experience, and a NYS Independent Adjuster license; remote work may be possible, and accuracy and integrity are essential.

Qualifications

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Proficiency with Windows; navigate multiple programs and applications.
• Ability to multi-task to resolve moderately complex claims.
• Valid NYS Independent Adjuster License (B Version) and renewals maintenance required.

Responsibilities

• Handle front end transactions including eligibility, entry of claims and matching.
• Process, adjudicate and/or adjust and research claims.
• Escalate trends and key patterns for review.
• Assist other processors and share knowledge.

Skills

Customer service

Claims processing

Multi-tasking

Attention to detail

Self-management

Education

High School diploma or equivalent

Job description

Capital District Physicians Health Plan Inc is seeking a Claims Examiner to resolve a wide range of claims transactions, including entry, adjudication or adjusting in accordance with MTM, NCQA and other mandated policies.

The role advances through Levels I–IV with increasing responsibility, requiring a high school diploma, claims processing experience, and a NYS Independent Adjuster license; remote work may be possible, and accuracy and integrity are essential.