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Leader, Claims Support

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 #384
Friday, November 8, 2019

Status: Full-time, Exempt   




This position supports the Leader of Operational support in facilitating, fostering and driving a sophisticated level of engagement activities and core competencies for both internal and external customers of MVP’s Claims department with outcome measures that focus on the member and provider experience. The role will provide oversight and direction in the duties of monitoring attendance, personnel issues, and performance evaluations, interviewing and completing the disciplinary action process. Leader will support and mentor to successfully build highly skilled team members. Supervises a provider support team that will position Claims Operations as a member and provider-centric and service-oriented department that is equipped and empowered to resolve issues for external constituents within Claims Operations while ensuring a continuous feedback loop is in place. Ensures productivity, quality handling are achieved by the unit. Provides guidance and direction to team members and external departments. Responsible for staff scheduling to include: PTO time, back-up for employees and cross-training for extended absences. Monitors operational performance and proactively addresses issues prior to escalation to leadership. Provides direct oversight of claims processing activities related to Adjustments, Correspondence and Encounter Data with the objective of meeting production, timeliness and quality standards. Provide coaching/feedback to establish high performing teams including addressing employee departmental issues as needed. Participates in meetings and supports successful implementation for assigned projects using good judgement and decision making. Participates and assists in audits. Ability to maintain confidentiality and adhere to regulatory compliance issues as they exist and change from time to time. Proactive in identifying areas for efficiency improvement across all of Claims Operations; consistently challenges the status quo in favor of incremental improvement opportunities that could be achieved through new methods. Performs other related duties as assigned.




Minimum Education:

Associates Degree preferred, equivalent experience may be substituted if the candidate can demonstrate significant relevant work experience.


Minimum Experience:

Minimum of 5 years claims experience in health insurance. Minimum of 3 years supervisory experience.  Knowledge of ICD-10, CPT-4, HCPCS coding preferred.    


Required Skills:

• Strong proficiency in problem solving and analysis

• Demonstrated ability to interact with all levels of management

• Adaptability and flexibility in a changing environment required

• Ability to use Excel, Microsoft Office, Power Point

• Ability to lead cross functional teams

• Excellent presentation skills

• Excellent follow up skills

• Excellent verbal and written communication skills

Other details

  • Job Family Claims/Operations
  • Pay Type Salary
  • Headquarters Office, 625 State Street, Schenectady, New York, United States of America
  • Rochester Office, 220 Alexander Street, Rochester, New York, United States of America