Claims Examiner I-IV | Adjudication & Processing, Remote

Capital District Physicians Health Plan Inc; City of Rochester (NY); Hybride; USD 28 000 - 33 000; Plein temps

Résumé du poste

Capital District Physicians Health Plan Inc. is seeking a Claims Examiner to process and adjudicate a wide range of claims, ensuring accuracy and compliance with MTM, NCQA, and policy requirements.

The role requires the ability to work across multiple programs, maintain privacy, and escalate trends or issues for resolution. A high school diploma and relevant experience are preferred. Some remote work may be possible.

Qualifications

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Capacity to continuously develop skills necessary for growth.

Responsabilités

• Handle front end transactions including member eligibility and claim processing.
• Process, enter, adjudicate and/or adjust claims.
• Collaborate with internal departments to resolve issues.

Connaissances

Customer service

Claims processing

Attention to detail

Multi-tasking

Formation

High School diploma or equivalent

Outils

Windows OS

Description du poste

Capital District Physicians Health Plan Inc. is seeking a Claims Examiner to process and adjudicate a wide range of claims, ensuring accuracy and compliance with MTM, NCQA, and policy requirements.

The role requires the ability to work across multiple programs, maintain privacy, and escalate trends or issues for resolution. A high school diploma and relevant experience are preferred. Some remote work may be possible.