Schenectady, New York - Posted on: Friday 03/21/14
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 Supervisor. Keeps abreast of all benefit changes. Provides ongoing feedback to the senior or Claims Operations
Supervisor to insure all appropriate personnel are kept informed. Performs other duties as assigned.
Minimum Experience: Previous claims processing/health insurance experience required.
- Independent Adjusters License is required. (If not certified when hired or transferred into position, must
obtain in the next IAC training class.)
- Strong communication skills
- Organizational skills and attention to detail;
- Strong PC skills required, Microsoft Windows experience highly desired