Senior Claims Examiner & Adjudication Specialist

Capital District Physicians’ Health Plan, Inc.; DeWitt (MI); Presencial; USD 44.000 - 68.000; Jornada completa

Descripción de la vacante

Capital District Physicians’ Health Plan, Inc. is seeking a Claims Examiner to resolve a wide variety of claims transactions, including entry, adjudication and adjustments, in line with MTM, NCQA, and PIP requirements.

This role progresses through Level I–IV with responsibilities ranging from basic claims processing to complex adjustments, trend identification, risk communication, and mentoring peers.

Formación

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Ability to navigate in a Windows environment and multi-task across programs.

Responsabilidades

• Process, adjudicate, or adjust and research claims.
• Identify trends and communicate risk to leadership.
• Provide mentorship and coaching to peers.

Conocimientos

Customer service

Claims processing

Multi-tasking

Attention to detail

Communication

Problem solving

Educación

High School diploma or equivalent

NYS Independent Adjuster License

Herramientas

Windows environment

Descripción del empleo

Capital District Physicians’ Health Plan, Inc. is seeking a Claims Examiner to resolve a wide variety of claims transactions, including entry, adjudication and adjustments, in line with MTM, NCQA, and PIP requirements.

This role progresses through Level I–IV with responsibilities ranging from basic claims processing to complex adjustments, trend identification, risk communication, and mentoring peers.