Analyst II – State Group Claims Auditor
Job Description:
• Independently perform audits and analysis of State Group claims utilizing standard audit practices
• Ability to research and analyze provider contracts to ensure accurate claims processing
• Identify incorrect application of State Group benefits, and analyze Benefit Narrative Viewer data
• Provide education and training to staff and management on defects, updates and improvements to guidelines, processes and procedures
• Analyze claims data to detect trends, patterns and system issues
• Research and resolve claims issues, working with internal stakeholders as needed
• Identify, recommend, implement and monitor processes, procedures, system enhancements and/or program improvements.
• Ensure State claims are paid in accordance with State benefits, provider contracts, and Florida Blue policies
• Maintain reports and dashboards to track audit findings, trends, and resolution progress
• Develop and implement audit plans, tools, and procedures to ensure thorough and efficient audits
• Document and communicate audit findings, conclusions, and recommendations to management and other stakeholders
Requirements:
• 2+ years Claims Processing Experience
• Related Bachelor’s degree or additional related equivalent work experience
• Strong analytical skills and problem-solving skills
• Attention to detail and ability to maintain confidentiality
• Proficiency in MS Office, MS Teams, and intermediate-level MS Excel skills
• Excellent communication and interpersonal skills, with ability to effectively communicate with internal and external stakeholders
Benefits:
• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available;
• A comprehensive wellness program
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• Independently perform audits and analysis of State Group claims utilizing standard audit practices
• Ability to research and analyze provider contracts to ensure accurate claims processing
• Identify incorrect application of State Group benefits, and analyze Benefit Narrative Viewer data
• Provide education and training to staff and management on defects, updates and improvements to guidelines, processes and procedures
• Analyze claims data to detect trends, patterns and system issues
• Research and resolve claims issues, working with internal stakeholders as needed
• Identify, recommend, implement and monitor processes, procedures, system enhancements and/or program improvements.
• Ensure State claims are paid in accordance with State benefits, provider contracts, and Florida Blue policies
• Maintain reports and dashboards to track audit findings, trends, and resolution progress
• Develop and implement audit plans, tools, and procedures to ensure thorough and efficient audits
• Document and communicate audit findings, conclusions, and recommendations to management and other stakeholders
Requirements:
• 2+ years Claims Processing Experience
• Related Bachelor’s degree or additional related equivalent work experience
• Strong analytical skills and problem-solving skills
• Attention to detail and ability to maintain confidentiality
• Proficiency in MS Office, MS Teams, and intermediate-level MS Excel skills
• Excellent communication and interpersonal skills, with ability to effectively communicate with internal and external stakeholders
Benefits:
• Medical, dental, vision, life and global travel health insurance;
• Income protection benefits: life insurance, short- and long-term disability programs;
• Leave programs to support personal circumstances;
• Retirement Savings Plan including employer match;
• Paid time off, volunteer time off, 10 holidays and 2 well-being days;
• Additional voluntary benefits available;
• A comprehensive wellness program
Apply Now
Apply Now