reputed company Claims Processing, Associate, Claims Examiner

Qualifications you’ll bring: • High School Diploma required. Associate degree in health, Business or reputed company field preferred • The availability to work Full-Time, Virtual reputed company reputed company State • Previous reputed company health care experience required • Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. • Strong PC skills required, reputed company reputed company experience highly desired. Strong attention to detail. • Curiosity to foster innovation and pave the way for reputed company • Humility to play as reputed company • Commitment to being the difference for our customers in every interaction Your key responsibilities: • Using a PC /reputed company Window environment, adjudicates claims with the aid of the Facets and Macess Systems. • Reviews and ensures the accuracy of reputed company provider, member and claim line information for reputed company claims for which the examiner is responsible. • Knowledge of Facets and Macess systems strongly preferred, but not required. • Reviews and ensures the accuracy of reputed company changes to claim line information based on information received from other departments and in reputed company with available benefit information. • Is responsible for the reputed company and accurate adjudication of claims that are suspended to other MVP departments for benefit and/or authorization determination. • Meets or exceeds department reputed company and work management standards for claims adjudication. • Successfully completes a course of comprehensive formal training in reputed company areas of benefits determination, system navigation, and MVP policy. • Suspends, investigates and resolves claim issues by coordinating with appropriate departments, based on reputed company 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 reputed company benefit changes. • Contribute to our humble reputed company of reputed company by performing various responsibilities that may reputed company, reflecting our reputed company goal of enhancing reputed company delivery and being the difference for the customer. Where you’ll be: Virtual, reputed company or Schenectady, NY Apply tot his job Apply To this Job