Title: Associate, Claims Examiner Location: Virtual US NY Remote Full time job requisition id JR100219 Job 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: - High School Diploma required. Associate degree in health, Business or related field preferred - The availability to work Full-Time, Virtual in Schenectady or Rochester - Previous related health care experience required - Knowledge of CPT, HCPCS, ICD-9-CM coding systems and Medical terminology preferred. - Strong PC skills required, Microsoft Windows experience highly desired. Strong attention to detail. - 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: - 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. - Knowledge of Facets and Macess systems strongly preferred, but not required. - 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. - Keeps abreast of all benefit changes. - 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 Rochester, NY or Schenectady, NY 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. $20.00-$26.60 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.

Role Description Step into a role where your client service expertise makes a meaningful impact. We are looking to add a Liability Claims Specialist to join our Creative Risk Solutions team. Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. - Review coverage for commercial auto and general liability claims. - Adjudicate claims, investigate bodily injury/liability claims, and negotiate settlements using "Best Practices for Claims." - Maintain accurate loss information and establish/maintain reserves within authority. - Research and respond to questions and complaints from insureds, claimants, agency partners, and carriers. - Monitor and control litigated claims, ensuring timely responses and protection of insureds' and carriers' interests. - Participate in claim reviews and Risk Control Workshops. - Identify and pursue subrogation and report fraud when applicable. - Train and mentor Liability Claims Specialists I and II. Qualifications - Education: High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. - Licensing: Active state specific adjusters license required or the ability to acquire license within three months of hire. - Experience: 5+ years of adjusting property and casualty claims. Prior agency involvement preferred. - Skills & Technical Competencies: - Knowledge of both general and auto liability coverages, claims processing procedures. - Ability to perform complex mathematical calculations. - Ability to learn multiple state insurance regulations and pass state licensing exams. - Understand and apply claims principles, practices, and insurance coverage interpretation for consulting, evaluating, and resolving claims. - Contributes to workflows while utilizing resources to deliver a world-class client experience and ensure compliance. - Fosters relationships by understanding relevant parties, prioritizing problem-solving, and collaborating to deliver impactful solutions. Benefits - Paid Parental Leave and supportive New Parent Benefits. - Company paid continuing Education & Tuition Reimbursement. - 401k Profit Sharing. - Generous time off practices in addition to paid holidays. - Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities. - DE&I programs including a paid Diversity Day time off option. - Consistent merit increase and promotion opportunities. - Discretionary bonus opportunity. Company Description Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies.

Role Description Step into a role where your client service expertise makes a meaningful impact. We are looking to add a Liability Claims Specialist to join our Creative Risk Solutions team. Creative Risk Solutions (CRS), a proud line of business under the Holmes Murphy umbrella, is a leading Third-Party Administrator (TPA) specializing in innovative claims management solutions. At CRS, we believe in doing things differently—empowering our team to deliver exceptional service, embrace creativity, and make a real impact for our clients. - Review coverage for commercial auto and general liability claims. - Adjudicate claims, investigate bodily injury/liability claims, and negotiate settlements using "Best Practices for Claims." - Maintain accurate loss information and establish/maintain reserves within authority. - Research and respond to questions and complaints from insureds, claimants, agency partners, and carriers. - Monitor and control litigated claims, ensuring timely responses and protection of insureds' and carriers' interests. - Participate in claim reviews and Risk Control Workshops. - Identify and pursue subrogation and report fraud when applicable. - Train and mentor Liability Claims Specialists I and II. Qualifications - High school diploma; college degree preferred. Technical designations encouraged, such as AIC and CPCU. - Active state specific adjusters license required or the ability to acquire license within three months of hire. - 5+ years of adjusting property and casualty claims. Prior agency involvement preferred. - Knowledge of both general and auto liability coverages, claims processing procedures. - Ability to perform complex mathematical calculations and learn multiple state insurance regulations. - Understand and apply claims principles, practices, and insurance coverage interpretation for consulting, evaluating, and resolving claims. - Contributes to workflows while utilizing resources to deliver a world-class client experience and ensure compliance. - Fosters relationships by understanding relevant parties, prioritizing problem-solving, and collaborating to deliver impactful solutions. Benefits - Paid Parental Leave and supportive New Parent Benefits. - Company paid continuing Education & Tuition Reimbursement. - 401k Profit Sharing with annual contributions from Holmes Murphy. - Generous time off practices in addition to paid holidays. - Supportive of community efforts with paid Volunteer time off and employee matching gifts to charities. - DE&I programs with a paid Diversity Day time off option. - Consistent merit increase and promotion opportunities. - Discretionary bonus opportunity. Company Description Creative Risk Solutions is a leading provider of innovative risk management solutions. We specialize in delivering customized claims management, loss control, and risk consulting services to our clients. Our team is dedicated to excellence, integrity, and creating value for our clients through proactive risk management strategies. In addition to being great at what you do, we place a high emphasis on building a best-in-class culture. We do this through empowering employees to build trust through honest and caring actions, ensuring clear and constructive communication, establishing meaningful client relationships that support their unique potential, and contributing to the organization's success by effectively influencing and uplifting team members.

• Initiate the investigation of new claims • Evaluate coverage and make appropriate policy decisions • Evaluate and negotiate settlements of collision, specified perils, and property damage • Manage and oversee the work of outside adjusters and appraisers • Develop basic understanding of liability and coverage principles • Recognize state specific laws and claims regulations • Summarize and make recommendations for disposition of claims • Respond to time sensitive materials including intercompany arbitration hearings • Manage a diary system to systematically review and resolve claims • Maintain state license