SIU Data Coordinator - Schenectady or Rochester
MVP Health Care - Rochester, NY

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Under the direction of the SIU Supervisor: Position will analyze claim data and coverage data to assist in the investigation process. Processes STARSentinel duplicate claim reports monthly and report findings to SIU and Operations management. Works with SIU Investigators to properly calculate amounts claims were overpaid based on investigative findings and makes claim adjustments accordingly. Works closely with various MVP departmental liaisons to keep up on system enhancements, contractual changes and other issues that could directly impact investigative and claim payment results. Assists in training coworkers during SIU annual training presentations. Processes and adjudicates, on an as needed basis, claims associated to SIU investigations/audits. Performs other duties as assigned. Minimum Education: Associates degree or equivalent combination of education and related claims experience required. Bachelor s degree preferred. NYS Independent Adjuster License required. If not certified when hired or transferred into position, individual must obtain in the next IAC training class. Minimum Experience: Minimum 3-5 years Facets claim processing experience required, including all claim types and lines of business. Claims adjusting experience preferred. Required Skills: Consistent outstanding and exceptional claims processing quality. Ability to utilize various data management tools to help identify potential fraudulent and/or abusive activity, including extensive working knowledge of Facets, MS Word, MS Excel, and other data mining tools. Superior judgment, analytical, verbal and written communication and presentation skills. Extremely detail oriented with excellent organizational and analytical skills. Preferred Skills: Strong knowledge of various MVP provider contracts with regards to benefits and claim payments. Working knowledge of Macess and Max MC

Requirements:

MVP Health Care - 13 months ago - save job - block
About this company
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MVP Health Plan covers about 650,000 most valuable people. Also known as MVP Health Care, the company provides health insurance and employee...