Company: MetroPlus Health Plan
Location: Jersey City
Posted on: January 16, 2022
About NYC Health + HospitalsMetroPlus Health Plan provides the
highest quality healthcare services to residents of Bronx,
Brooklyn, Manhattan, Queens and Staten Island through a
comprehensive list of products, including, but not limited to, New
York State Medicaid Managed Care, Medicare, Child Health Plus,
Exchange, Partnership in Care, MetroPlus Gold, Essential Plan, etc.
As a wholly-owned subsidiary of NYC Health + Hospitals, the largest
public health system in the United States, MetroPlus ' network
includes over 27,000 primary care providers, specialists and
participating clinics. For more than 30 years, MetroPlus has been
committed to building strong relationships with its members and
providers to enable New Yorkers to live their healthiest life.
-Position OverviewIncumbent audits completed data entry and
adjudicated claims. Incumbent produces detailed monthly statistical
reports to assist the Manager in assessing employee 's performance
as it relates to quality.Job Description
- Audit work of claims examiners to ensure quality.
- Identify policies or common errors requiring retraining
- Participate in quality projects as required.
- Collect, analyze data, identify trends, write reports (i.e.,
the monthly and quarterly reports) and present findings to the
appropriate Claims Service management personnel.
- Other duties as assigned by the Director of the Claims
Department and the Manager of the Claims Service UnitMinimum
- Must be able to perform all the duties and responsibilities of
subordinate claims examiners within the department.
- Must be able to communicate adequately both verbal &
- Must have excellent interpersonal skillsProfessional
- Integrity and Trust
- Customer Focus
- Functional/Technical skills
- Written/Oral Communication
Keywords: MetroPlus Health Plan, Jersey City , CLAIMS AUDITOR, Accounting, Auditing , Jersey City, New Jersey
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