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

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

Analyst II – State Group Claims Auditor

Key skills