Benefits Management Analyst

What are important things that YOU need to know about this role?

• This position is eligible to be fully remote

• SQL Experience is be required

• Power BI Experience Preferred

• We are open to Level 1 or Level 2 Candidates

  • Salary Level 1: Range: $55,014 - $82,522

  • Salary Level 2: Range: $69,014 - $103,520

What will YOU be doing for us? The Benefit Management Analyst II analyzes and monitors provider behavior to promote appropriate care to members while controlling costs for our clients, measuring provider data and when necessary addressing abnormalities. Collaborates with other areas including client experience team, clinical, provider relations and developers.

What will YOU be working on every day?

• Analyze provider data to identify outlier provider performance. Provide in-depth analysis of data/provider payments to determine potential outliers or data trends. Identifies root cause issue and communicates findings to appropriate staff and make appropriate recommendations (increased monitoring etc.).

• Must have technical capabilities in a programming language to manipulate, analyze, interpret and report on large volumes of data

• Ensure all cases are properly documented for reference and review.

• Assist with communication to clients regarding network abnormalities and outcomes.

• Develop and recommend action plans for enhancing benefit outcomes to members while controlling costs.

• Work with internal staff to make them aware of potential abnormalities and develop a plan to rectify.

• Communicate with providers regarding specific questions surrounding audits, procedures, and communications.

• Develop and maintain processes and all relevant documentation used to take corrective actions with providers.

• Follow company guidelines for changing provider behavior and/or removing outlier providers, when abnormal behavior is identified.

• Create and regularly review standard benchmarks for each market regarding network performance.

• Coordinate targeted provider’s random chart audits to ensure standards are met and appropriate peer committee reviews.

• Utilize internal systems to generate information and analyze using system reports and write moderately complex SQL queries.

• Contributing member for cross functional work teams tasked with identifying opportunities for Enterprise System enhancements to more accurately process data in an efficient and adherent manner to program design.

• Support in identifying new trends for monitoring and dealing with fraud, waste, and abuse.

• Support innovation with financial analysis improvements and new cost containment tools.

What qualifications do YOU need to have to be GOOD candidate?

• Required

  • Level 1: Associates Degree/Two Year Degree in math/stats/finance/accounting or a related field of study is required.  

  • Level 2: Bachelor’s degree in math/stats/finance/accounting or a related field of …