Perform analysis, reconciliation, auditing, and reporting functions within the Claims Department.
Research and gather current claims and financial information to analyze trends, reconcile system data, audit for errors, and generate internal and external reporting.
Look for operating efficiencies and recommend corrective actions as necessary.
Examine trends, claim statistics, and provider payments in order to monitor achievement of department goals, improve processes, and determine claims processing accuracy/timeliness.
Reconcile data flow between processing systems; identify and report any discrepancies.
Generate internal and external reporting of claims statistics, including data by fund source, disability, and service category.
Maintain monthly/weekly/quarterly claims statistics and auditing spreadsheets (i.e., claim denials, claims processed, etc.).
Effectively analyze data and trends and utilize quality management tools to improve organizational performance.
Develop and present management reports.
Continually assess and redesign, where appropriate, claims analysis, reconciliation, auditing, and reporting processes.
Review claims data for audits and reviews to determine claims processing accuracy and reporting validity/integrity.

High School diploma/GED and six (6) years of experience in business, accounting, or financial analysis; OR Associate’s degree and four (4) years of experience in business, accounting, or financial analysis; OR Bachelor’s degree and two (2) years of experience in business, accounting, or financial analysis; OR Equivalent combination of education/experience.
Must have a valid driver’s license
Must reside within North Carolina
Must be able to travel within catchment as required.
Experience in the areas of accounting, data analysis, data management, statistics, reporting, and use of databases.

Senior Financial Analyst – Claims

Key skills