Senior Claims Examiner: Complex Adjudication & Mentorship

Capital District Physicians Health Plan Inc; Town of De Witt (NY); Vor Ort; USD 42.000 - 66.000; Vollzeit

Zusammenfassung

CDPHP is seeking a Claims Examiner in New York to resolve a wide range of claims transactions, including entry, adjudication, and adjustments in alignment with MTM, NCQA, and company policies. Level I–IV responsibilities scale with experience and licensing requirements.

Role emphasizes accuracy, privacy, and collaboration with internal teams, with opportunities for professional growth and case handling across multiple levels.

Qualifikationen

• High School diploma or equivalent required.
• Minimum of 1 year progressive claims processing or customer service experience.
• Ability to analyze and resolve moderately complex situations/transactions.
• Proficient in navigating Windows-based programs and multiple applications.

Aufgaben

• Handle front end transactions including member eligibility and claims entry.
• Process, adjudicate, and/or adjust and research claims.
• Identify patterns impacting quality, claim inventory, and customer experience and escalate as needed.
• Communicate effectively with internal/external customers to promote satisfaction.

Kenntnisse

Customer service

Claims processing

Attention to detail

Communication

Multi-tasking

Ausbildung

High School diploma or equivalent

NYS Independent Adjuster License

Tools

Windows OS

Jobbeschreibung

CDPHP is seeking a Claims Examiner in New York to resolve a wide range of claims transactions, including entry, adjudication, and adjustments in alignment with MTM, NCQA, and company policies. Level I–IV responsibilities scale with experience and licensing requirements.

Role emphasizes accuracy, privacy, and collaboration with internal teams, with opportunities for professional growth and case handling across multiple levels.