Full Description

Join Us in Shaping the Future of Health Care At MVP Health Care, we’re on a mission to create a healthier future for everyone. That means embracing innovation, championing equity, and continuously improving how we serve our communities. Our team is powered by people who are curious, humble, and committed to making a difference—every interaction, every day. We’ve been putting people first for over 40 years, offering high-quality health plans across New York and Vermont and partnering with forward-thinking organizations to deliver more personalized, equitable, and accessible care. As a not-for-profit, we invest in what matters most: our customers, our communities, and our team. What’s in it for you: Growth opportunities to uplevel your career A people-centric culture embracing and celebrating diverse perspectives, backgrounds, and experiences within our team Competitive compensation and comprehensive benefits focused on well-being An opportunity to shape the future of health care by joining a team recognized as a Best Place to Work For in the NY Capital District, one of the Best Companies to Work For in New York, and an Inclusive Workplace. You’ll contribute to our humble pursuit of excellence by bringing curiosity to spark innovation, humility to collaborate as a team, and a deep commitment to being the difference for our customers. Your role will reflect our shared goal of enhancing health care delivery and building healthier, more vibrant communities. Qualifications you’ll bring: An associate’s degree or equivalent combination of education and related experience The availability to work full-time, virtual within New York State. Two years’ experience testing/auditing health care claims, provider data or configuration preferred. Five or more years’ experience processing medical claims in lieu of previous auditing/testing experience. Experience working with Word, Excel and Database Query Tool. Excellent written and verbal communication skills, including the ability to facilitate meetings including those with external partners. Able to coordinate activities among multiple groups for external testing. Curiosity to foster innovation and pave the way for growth Humility to play as a team Commitment to being the difference for our customers in every interaction Your key responsibilities: Responsible for the accurate and timely testing of configuration required to accommodate systematic provider reimbursement, adjudication rules and benefit plan requirements in Facets. Responsible for the interpretation of requests, development of test plan, test strategies, solutions, and file creation in support of efficient and accurate claim adjudication. Responsible for the coordination and delivery of testing results to external provider groups as required for project implementations. Maintains detailed documentation related to work assignments to support audit processes including test plans, test case scenarios and detailed test scripts. Develops and executes queries to support the testing of configuration, adjudication rules and benefit plan designs. Identifies, tracks, and communicates configuration defects. Creates claim reports related to work assignments that will be shared within Operations Claims for validation. Collaborate with internal partners to understand configuration requirements needed to successfully validate benefit plan designs. Responsible for timely investigation and resolution of claim review inquiries from internal customers. Prepare detailed analyses and reports for internal customers when necessary. Follow existing procedures and participates in root cause analysis meetings. Recommends and implements process improvements. Provides support in the development, improvement and automation of testing and QC processes. Contribute to our humble pursuit of excellence by performing various responsibilities that may arise, reflecting our collective goal of enhancing healthcare delivery and being the difference for the customer. Where you’ll be: Virtual within New York State #cs Pay Transparency MVP Health Care is committed to providing competitive employee compensation and benefits packages. The base pay range provided for this role reflects our good faith compensation estimate at the time of posting. MVP adheres to pay transparency nondiscrimination principles. Specific employment offers and associated compensation will be extended individually based on several factors, including but not limited to geographic location; relevant experience, education, and training; and the nature of and demand for the role. We do not request current or historical salary information from candidates. $51,395.00-$68,354.75 MVP's Inclusion Statement At MVP Health Care, we believe creating healthier communities begins with nurturing a healthy workplace. As an organization, we strive to create space for individuals from diverse backgrounds and all walks of life to have a voice and thrive. Our shared curiosity and connectedness make us stronger, and our unique perspectives are catalysts for creativity and collaboration. MVP is an equal opportunity employer and recruits, employs, trains, compensates, and promotes without discrimination based on race, color, creed, national origin, citizenship, ethnicity, ancestry, sex, gender identity, gender expression, religion, age, marital status, personal appearance, sexual orientation, family responsibilities, familial status, physical or mental disability, handicapping condition, medical condition, pregnancy status, predisposing genetic characteristics or information, domestic violence victim status, political affiliation, military or veteran status, Vietnam-era or special disabled Veteran or other legally protected classifications. To support a safe, drug-free workplace, pre-employment criminal background checks and drug testing are part of our hiring process. If you require accommodations during the application process due to a disability, please contact our Talent team at . At MVP Health Care, we’re more than a health insurance company—we’re a mission-driven organization committed to creating a healthier future for all. We believe in the power of innovation, collaboration, and continuous improvement to drive meaningful change.