Leader, Claims Operations - MVP Health Care : Job Details

At MVP Health Care, we're on a mission to create a healthier future for everyone - which requires innovative thinking and continuous improvement. To achieve this, we're looking for a Leader, Claims Operations, to join #TeamMVP. If you have a passion for leadership, team development and operational excellence this is the opportunity for you.

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 and one of the Best Companies to Work For in New York

Qualifications you'll bring:

• A bachelor's degree or equivalent combination of education and related

experience.

• The availability to work full-time, hybrid.

• Minimum 3 years in health insurance or production-related environment. 2 years claims processing experience preferred.

• Strong knowledge of Medicaid, Medicare, and Commercial claims processing.

• Familiarity with ICD-10, CPT, HCPCS, and Revenue codes.

• 2 years' supervisory experience is preferred. 1-year direct vendor oversight experience is preferred. 2 years project oversight experience preferred

• 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 overseeing the end-to-end adjudication and processing of claims across Medicaid, Medicare, Commercial, Cigna, and Data Entry operations.

• Provides strategic leadership, vendor oversight, and operational management to ensure timely, accurate, and compliant claims processing.

• Drive process improvements, support cross-functional initiatives, and mentor a high-performing team to meet organizational goals.

• Lead and manage claims teams across Medicaid, Medicare, Commercial, and Data Entry functions.

• Ensure productivity and quality standards are consistently met.

• Provide oversight of vendor relationships including Cigna and Data Entry partners.

• Supervise and mentor claim examiners and seniors to build a highly skilled team.

• Conduct goal setting, performance evaluations, and disciplinary actions as needed.

• Ensure compliance with regulations and company policies

• Address internal and external customer inquiries and complaints.

• 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:

Schenectady, NY or Rochester, NY- Hybrid

#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.

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 [email protected] .

Job Details

Job Family Claims/Operations

Pay Type Salary

Hiring Min Rate 56,200 USD

Hiring Max Rate 80,114 USD