Claims Examiner – Growth Path & Impact (Remote Possible)

Capital District Physicians Health Plan Inc; City of Albany (NY); Hybrid; USD 28,000 - 45,000; Full time

Job summary

Capital District Physicians Health Plan Inc (CDPHP) is seeking a Claims Examiner to resolve a wide range of claims transactions, from entry to adjudication and adjusting, in alignment with MTM, NCQA, and PIP guidelines. This role progresses through Level I to IV responsibilities emphasizing accuracy, privacy, and collaboration.

The position requires a high school diploma, basic computer skills, and progressively responsible claims processing experience.

Qualifications

• High School diploma or equivalent.
• Experience in customer service or claims processing preferred.
• License: NYS Independent Adjuster required and renewals maintained.

Responsibilities

• Handle front end transactions including member eligibility and claim processing.
• Process, adjudicate and/or adjust and research claims.
• Identify trends and escalate for review or investigation when needed.
• Collaborate with internal departments and communicate with customers to ensure satisfaction.

Skills

Multi-tasking

Attention to detail

Self-management

Customer service

Education

NY State Independent Adjuster License

Job description

Capital District Physicians Health Plan Inc (CDPHP) is seeking a Claims Examiner to resolve a wide range of claims transactions, from entry to adjudication and adjusting, in alignment with MTM, NCQA, and PIP guidelines. This role progresses through Level I to IV responsibilities emphasizing accuracy, privacy, and collaboration.

The position requires a high school diploma, basic computer skills, and progressively responsible claims processing experience.