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Join the APWU Health Plan team

APWU Health Plan is a great place to work. We offer a competitive salary; health, dental and vision insurance; 401(k); generous vacation leave; company paid pension; and tuition reimbursement.
Open positions

Email your resume and cover letter to hr@apwuhp.com.


Claims Supervisor

The Claims Supervisor is responsible for managing the claims inventory and resources through the timely and accurate processing of higher level claims. This position also manages the processing of claims adjustments through the correction of processing errors and handling overpayments or underpayments.


RESPONSIBILITIES
  • Meet given objectives to cycle time, QA and productivity
  • Operate within the unit administrative budget
  • Manage unit workflow and inventory
  • Manage reporting of daily/monthly – ad hoc of the unit
  • Update standards and write/update unit procedures on a timely basis
  • Administer Plan personnel policies/CBA accurately and equitably
  • Complete assignments in a timely manner
  • Initiate IT tickets for system issues
  • Respond to other departments’ inquiries timely
  • Train staff as needed
  • Other duties as assigned
QUALIFICATIONS
  • AA degree (or commensurate experience) preferred
  • Minimum of 3 years claims experience
  • Minimum of 3 years of experience in a supervisory position
  • Must have QNXT processing experience
  • Decision-making and problem-solving skills
  • Ability to prioritize, organize tasks and develop the necessary action plans to accomplish specific goals within required deadlines
  • Motivational/leadership skills
  • Good verbal and written communication skills
  • Self-motivated and ability to take initiative

Business Analyst — Code Auditing

The APWU Health Plan, a non-profit organization located in Glen Burnie, MD, is seeking a Business Analyst – Code Auditing to join our Applications Development Department. The incumbent is primarily responsible for supporting and enhancing the code auditing application, Claim Check or its equivalent, to include the maintenance of codes, knowledgebases, rules and all other appropriate auditing updates. Also, responsible for recommending improved methods/alternatives for operations.


RESPONSIBILITIES
  • Review, analyze and recommend coding approaches to minimize denials and pends but to ensure accurate payment for the provider.
  • Build, maintain and/or enhance code sets and knowledgebases.
  • Investigate requests by business customers for new and/or changes to existing system setup as well as conduct testing of code, rule and knowledgebase changes and enhancements.
  • Coordinate with Applications Development and Support manager and/or Team Lead, Applications Development to assure priority of new work (Governance).
  • Development or enhancements of reports to quantify the savings of the auditing.
  • Coordinate with the testing team for acceptance testing of changes and enhancements.
  • Other duties as assigned.
QUALIFICATIONS
  • B.S. degree preferred, but direct experience may be substituted.
  • CPC or CCA preferred.
  • A minimum of five years supporting code auditing applications such as CHC/McKesson’s ClaimsXten Select, Optum’s CES and/or McKesson’s Claim Check.
  • Thorough understanding of claims processing from an operational and systems point of view.
  • Excellent technical and analytical skills.
  • Good verbal and written skills.

EOE M/F/D/V; Drug-Free Employer


NOTE TO AGENCIES
We do not accept unsolicited resumes from third-party vendors. Only resumes received from contracted agencies/vendors will be considered. Unsolicited resumes sent to APWU Health Plan will not be recognized and such agency will have no recourse from APWU Health Plan.