What are important things that YOU need to know about this role?
Remote Work: This is a permanently remote position
Experience Requirements: SQL experience is required. Familiarity with Power
BI is preferred but not mandatory.
Work Hours: Flexible daytime hours, Monday through Friday. Core availability
between 9:00 AM and 3:00 PM CST is required, with flexibility around those
hours.
What will YOU be doing for us? The Benefit Management Analyst I supports the
analysis and monitoring of provider behavior to promote appropriate care to
members while controlling costs for our clients, measuring provider data and
maintains appropriate documentation for tracking activity and results for the
department. Collaborates with other areas including client experience team,
clinical, provider relations and developers.
What will YOU be working on every day?
Maintain all internal information in an organized manner, document and track
results of all departmental activity.
Analyze provider data to identify outlier provider performance. Provide
in-depth analysis of data/provider payments to determine potential outliers
or data trends. Assist with identifying root cause issue and communicate
findings to appropriate staff.
Ensure all cases are properly documented for reference and review.
Develop and recommend action plans for enhancing benefit outcomes to members
while controlling costs.
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.
What qualifications do YOU need to have to be GOOD candidate?
Required Level of Education, Licenses, and/or Certificates
Associates Degree/Two Year Degree in math/stats/finance/accounting or a
related field of study is required.
Required Level of Experience
1-3 years of job related experience
Required Knowledge, Skills, and Abilities
Intermediate knowledge of Excel, Word and PowerPoint.
Intermediate knowledge of email.
Able to remain organized with multiple interruptions.
High attention to detail.
Analytical skills that assist in ability to solve routine problems.
Excellent time management skills.
Good oral communication skills.
Ability to work well with a variety of individuals.
Ability to work well independently.
What qualifications do YOU need to have to be a GREAT candidate?
Bachelor’s degree in math/stats/finance/accounting or a related field of
study is preferred.
The salary range and midpoint is listed below for your reference. Please keep in
mind that your education and experience along with your knowledge, skills and
abilities are taken into consideration when determining placement within the
range.
Compensation Range: $55,014 - $82,522
Compensation Midpoint: 68,768
SKYGEN is the trusted partner for specialty benefits payers and government
agencies responsible for the delivery and administration of dental and vision
benefits. Through cutting-edge technology and service solutions, SKYGEN empowers
clients to become the most efficient, effective healthcare organizations in the
country.
Equal Opportunity Employer, including Protected Veterans and Individuals with
Disabilities.