Leader, Claims Processing- Alliance Partners

Headquarters Office, 625 State Street, Schenectady, New York, United States of America Req #746
Wednesday, March 3, 2021
Be a part of the transformation at MVP Health Care®. MVP Health Care is a nationally-recognized, regional not-for-profit health insurer. We care for more than 700,000 members across New York and Vermont and are powered by the ideas and energy of more than 1,700 employees. We employ talented people  with diverse backgrounds and experience—tech people, numbers people, even people people—to make health insurance more convenient, more supportive, and more personal. If you’re ready to join a thriving, mission-driven company where you can create your own opportunities—it’s time to make a healthy career move to MVP.

Full-Time, Exempt

Leader will provide direct oversight to the Cigna, Level Funding, and data entry teams including all aspects of associated vendor inventory management and direct support to those partnerships. Responsibilities will include ensuring that all activity is consistent
 
with company policies, procedures, and contractual or statutory guidelines, as well as preparation of materials for vendor oversight and executive review. Participation in vendor meetings and managing operational processes with vendor partners. Leader will also assist the Claims leadership team in forging process improvements in claims experience, including first pass, automation, and member or provider experience enhancements.

 

Leader will also support and mentor staff to build a highly skilled team. Leader will provide oversight and direction to staff including the duties of goal setting, performance evaluations, managing system time and attendance, and completing the disciplinary action process, if applicable.

 

The Leader will also lead Operations projects and be responsible for implementation of assigned projects, and other job duties as assigned.

   

POSITION QUALIFICATIONS 

 

Minimum Education:

Bachelors degree required, or equivalent experience

 

Minimum Experience:

2 years Claims experience. 1-year direct vendor oversight experience preferred.

Independent Adjusters License required( if not certified when hired or transferred into position, license must be obtained within a year, or in the next IAL training class.)

 

Required Skills: 

  • Familiar with ICD-10, CPT, HCPCS and Revenue codes
  • Strong commitment to customer service and understanding and responding to customer needs within specific timeframes
  • Strong problem-solving skills and demonstrated ability to follow through on issues to resolution
  • Strong verbal and written communication skills
  • Excellent time management skills
  • Ability to work independently as well as be an effective team member
  • Ability to prioritize multiple assignments with attention to details and deadlines in a high volume environment.
  • Excellent organization skills and attention to detail
  • Familiar with Word, Excel, Microsoft Office
#zip

MVP Health Care is an Affirmative Action/Equal Opportunity Employer (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), 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 hr@mvphealthcare.com.

Other details

  • Job Family Claims/Operations
  • Pay Type Salary
  • Headquarters Office, 625 State Street, Schenectady, New York, United States of America