Analyst II - State Group Claims Auditor
Job Summary
JOB DESCRIPTION
The Analyst II –State Grp Claims Auditor is responsible for conducting research, analysis, and auditing of State Group claims to ensure compliance with State benefits, Provider Contracts, and Florida Blue Payment Policies. This role is intended to identify errors, resolve potential defects, and detect system issues on a monthly basis, ultimately ensuring that State claims are paid accurately and efficiently.
Essential Functions
• 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
Required Qualifications
• 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
Preferred Experience
• 2+ years State Group Claims Processing Experience
• Working knowledge of State Group benefits
• Experience with claims auditing and analysis
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
What We Offer
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
• 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; and
• A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range: $50,300 - $81,800
Typical Annualized Hiring Range: $50,300 - $62,900
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.
Apply Now
Apply Now
JOB DESCRIPTION
The Analyst II –State Grp Claims Auditor is responsible for conducting research, analysis, and auditing of State Group claims to ensure compliance with State benefits, Provider Contracts, and Florida Blue Payment Policies. This role is intended to identify errors, resolve potential defects, and detect system issues on a monthly basis, ultimately ensuring that State claims are paid accurately and efficiently.
Essential Functions
• 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
Required Qualifications
• 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
Preferred Experience
• 2+ years State Group Claims Processing Experience
• Working knowledge of State Group benefits
• Experience with claims auditing and analysis
General Physical Demands
Sedentary work: Exerting up to 10 pounds of force occasionally to move objects. Jobs are sedentary if traversing activities are required only occasionally.
What We Offer
As a Florida Blue employee, you will thrive in our Be Well, Work Well, GuideWell culture where being well as an individual, and working well as a team, are both important in serving our members and communities.
To support your wellbeing, comprehensive benefits are offered. As an employee, you will have access to:
• 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; and
• A comprehensive wellness program
Employee benefits are designed to align with federal and state employment laws. Benefits may vary based on the state in which work is performed. Benefits for intern, part-time and seasonal employees may differ.
To support your financial wellbeing, we offer competitive pay as well as opportunities for incentive or commission compensation. We also conduct regular annual reviews with pay for performance considerations for base pay increases.
Annualized Salary Range: $50,300 - $81,800
Typical Annualized Hiring Range: $50,300 - $62,900
Final pay will be determined with consideration of market competitiveness, internal equity, and the job-related knowledge, skills, training, and experience you bring.
We are an Equal Employment Opportunity employer committed to cultivating a work experience where everyone feels like they belong and can perform at their best in pursuit of our mission. All qualified applicants will receive consideration for employment.
Apply Now
Apply Now