Commercial Claims Processing Associate, Claims Examiner

MVP Health Care; City of Schenectady (NY); Remote; USD 45,000 - 65,000; Full time

Job summary

MVP Health Care is seeking a Medical Claims Examiner to join their team in Schenectady, NY. This role involves analyzing claims, ensuring accuracy, and working within a supportive culture focused on innovation and healthcare delivery. Join a company recognized as one of the Best Places to Work in New York, and contribute to making a difference for customers through the claims process.

Benefits

Growth opportunities

Comprehensive benefits

People-centric culture

Qualifications

• High School Diploma required; Associate degree preferred.
• Previous related health care experience required.
• Knowledge of coding systems and medical terminology preferred.

Responsibilities

• Adjudicates claims using Microsoft Windows and Facets/Macess systems.
• Ensures accuracy of provider, member, and claim line information.
• Coordinates with departments to resolve claim issues.

Skills

Attention to detail

PC skills

Coding knowledge (CPT, HCPCS, ICD-9-CM)

Education

High School Diploma

Associate degree in health or related field

Tools

Microsoft Windows

Facets and Macess Systems

Job description

Headquarters Office, 625 State Street, Schenectady, New York, United States of America ● Rochester Office, 20 S. Clinton Ave, Rochester, New York, United States of America Req #2572

At MVP Health Care, we’re on a mission to create a healthier future for everyone – which requires innovative thinking and continuous improvement. To achieve this, we’re looking for a Medical Claims Examiner to join #TeamMVP. This is the opportunity for you if you have a passion for analyzing information.

What’s in it for you:

• Growth opportunities to uplevel your career
• A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team
• Competitive compensation and comprehensive benefits focused on well-being
• An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work for and one of the Best Companies to Work For in New York

Qualifications you’ll bring:

• High School Diploma required. Associate degree in health, Business or related field preferred
• The availability to work Full-Time, Virtual
• Previous related health care experience required
• Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred.
• Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail.
• Curiosity to foster innovation and pave the way for growth
• Humility to play as a team
• Commitment to being the difference for our customers in every interaction

Your key responsibilities:

• 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.
• Knowledge of Facets and Macess systems strongly preferred, but not required.
• 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.
• Keeps abreast of all benefit changes.
• Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer.

Where you’ll be:

Virtual within Rochester, NY or Schenectady, NY

Pay Transparency
MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role.

We do not request current or historical salary information from candidates.
MVP's Inclusion Statement
At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration.

MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications.

To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at [email protected] .

Health insurance plans, dental insurance plans, and medicare plans for individuals and employers in New York & Vermont from MVP Health Care.

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