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Analyst II – State Group Claims Auditor
Location
Florida
Posted
105 days ago
Salary
$50.3K - $81.8K / year
Seniority
Mid Level
Job Description
Analyst II – State Group Claims Auditor
GuideWell Source
• 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
Job 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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