Associate, Claims Examiner

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 Claims Examiner to join #TeamMVP. If you have a passion for medical claims and attention to detail this is the opportunity for you.

Full-Time, Non-Exempt

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 within New York State

• 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 New York State