Senior Claims Examiner: Complex Adjudication

Capital District Physicians Health Plan Inc; Town of Clinton (NY); Hybrid; USD 28,000 - 33,000; Full time

Benefits offered by this job

Remote work option

Job summary

Capital District Physicians Health Plan Inc. seeks a Claims Examiner to handle end-to-end eligibility, entry, adjudication and adjustment of claims across multiple levels.

Success requires attention to detail, strong customer service skills, and the ability to work with various internal teams in a Windows environment. Some role levels include mentorship and complex processing responsibilities.

Qualifications

• High School diploma or equivalent required.
• Relevant customer service or claims processing experience preferred.
• Capacity to continuously develop skills necessary for growth.
• Ability to navigate in a Windows environment and use multiple programs.

Responsibilities

• Handle front-end transactions including eligibility and claim processing.
• Identify patterns that impact quality, claim inventory, and customer experience and escalate for review.
• Process, adjudicate and/or adjust and research claims per procedures.
• Provide mentorship and training as levels progress and collaborate with internal departments.

Skills

Customer service

Claims processing

Attention to detail

Multi-tasking

Education

High School diploma

NYS Independent Adjuster License

Tools

Windows environment

Claims processing software

Job description

Capital District Physicians Health Plan Inc. seeks a Claims Examiner to handle end-to-end eligibility, entry, adjudication and adjustment of claims across multiple levels.

Success requires attention to detail, strong customer service skills, and the ability to work with various internal teams in a Windows environment. Some role levels include mentorship and complex processing responsibilities.