ASO Claims Associate, Claims Examiner
Company: MVP Health Care, Inc.
Posted on: May 16, 2022
ASO Claims Associate, Claims Examiner Headquarters Office, 625
State Street, Schenectady, New York, United States of America
- Rochester Office, 220 Alexander Street, Rochester, New York,
United States of America Req #1070 Friday, March 4, 2022 Over 35
years strong and fueled by 1,700 smart, passionate employees across
New York state and Vermont, MVP is full of opportunities to grow.
We are a nationally recognized, award-winning leader for a reason.
The beating heart of our company is a wide range of employees from
a diverse set of backgrounds-tech people, numbers people, even
people people-working together to make health insurance better. If
you are ready to join a thriving, mission-driven company where you
can create your own opportunities and make a positive
difference-it's time to make a healthy career move to MVP!
Full-Time, Non-exempt 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. 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. Reports same to Claims
Operations Leader. Keeps abreast of all benefit changes. Provides
ongoing feedback to the senior or Claims Operations Leader to
ensure all appropriate personnel are kept informed. Performs other
duties as assigned.POSITION QUALIFICATIONSMinimum Education: High
School Diploma required. Associates in Health, Business, or related
field preferred. Minimum Experience: Previous related health care
experience required. Health insurance experience preferred.
Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical
terminology preferred.Required Skills:
- Strong communication skills
- Organizational skills and attention to detail;
- Strong PC skills required, Microsoft Windows experience highly
desired About MVPMVP Health Care is a nationally recognized,
not-for-profit health insurer caring for more than 700,000 members
in New York and Vermont. Committed to the complete well-being of
our members and the communities we serve, MVP makes health
insurance more convenient, more supportive, and more personal. We
are powered by the ideas and energy of more than 1,700 diverse,
employees from all backgrounds, committed to having a positive
impact on the health and wellness of everyone we serve. MVP Health
Care is an Affirmative Action/ Equal Employment Opportunity (PDF).
We recruit, employ, train, compensate, and promote without regard
to race, religion, creed, color, national origin, age, gender,
sexual orientation, marital status, disability, genetic
information, veteran status, or any other basis, e.g., Pay
Transparency (PDF), and the EEO is the Law Poster and Supplement
protected by applicable federal, state or local law. Any person
with a disability needing special accommodations to the application
process, please contact Human Resources at firstname.lastname@example.org
Please apply and learn more - including how you may become a proud
member of our team.
Keywords: MVP Health Care, Inc., Schenectady , ASO Claims Associate, Claims Examiner, Other , Schenectady, New York
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