Job Details

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INSURANCE ANALYST
Job Details
Location US, AL, MONTGOMERY
Job Type Insurance
Job Class Exempt

Description
Position # 2434301

Job Description:33930 – INSURANCE ANALYST: UNDER GENERAL SUPERVISION, PERFORMS ACTIVITIES IN PROVIDER RELATIONS, MEDICAL REVIEW, PROVIDER ENROLLMENT, PROVIDER CORRESPONDENCE, AND POLICY REVIEW. CONDUCTS AUDITS TO REVIEW ACCURACY OF COST REPORTS AND PAYMENT OF CLAIMS. EXAMINES CLAIMS AND REPORTS TO ENSURE PROPER RECORDING OF TRANSACTIONS AND COMPLIANCE WITH CLIENT-COMPANY POLICY AND/OR STATE AND FEDERAL REGULATIONS. CALCULATES AND MAINTAINS RECORDS OR RECOUPMENT. REVIEWS INQUIRIES FROM PROVIDERS REGARDING COST REPORT SETTLEMENTS. ANALYZES DATA OBTAINED FOR EVIDENCE OF FRAUD OR LACK OF COMPLIANCE WITH ESTABLISHED POLICIES OR PROCEDURES. ENSURES ACCURATE AND TIMELY COMPLETION AND SUBMISSION OF FEDERALLY MANDATED FINANCIAL AND STATISTICAL REPORTS. REFERS QUESTIONABLE CLAIM ISSUES TO THE APPROPRIATE DEPARTMENT. CONDUCTS VISITS TO PROVIDER LOCATIONS FOR EDUCATION AND TRAINING ON PROCEDURES. ASSISTS IN PREPARATION AND ANALYSIS OF COST/BUSINESS PROPOSALS. PREPARES REPORTS OF FINDINGS AND MAKES RECOMMENDATIONS TO MANAGEMENT. (2/94)

Job Essential Functions:33930 – INSURANCE ANALYST: ABILITY TO CONDUCT AUDITS TO REVIEW ACCURACY OF COST REPORTS AND PAYMENT OF CLAIMS. ABILITY TO ANALYZE DATA TO DETECT IRREGULARITIES, ERRORS, FRAUD, OR LACK OF COMPLIANCE WITH ESTABLISHED POLICIES OR PROCEDURES. ABILITY TO PREPARE STATISTICAL DATA AND REPORTS FOR FEDERAL/STATE AGENCIES. ABILITY TO CALCULATE RECOUPMENTS.

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