Benefit Assurance Analyst

at  ASEBP

POSITION SUMMARY

An ASEBP Benefit Analyst is tasked with working to ensure certain claims from across all lines of benefits offered by ASEBP are submitted and adjudicated as per the plan documents and service agreements, as well as being free of fraud and abuse. Utilizing an anonymous tip line, routine monitoring and advanced analytics the Benefit Analyst role works to ensure continued viability of ASEBP’s benefit plan.

YOUR EDUCATION AND EXPERIENCE

• Three to five years of related benefit experience and customer service.
• Strong computer skills in Microsoft Office.
• Minimum of two years of experience in data analysis, demonstrating strong investigative skills to uncover trends, patterns, and insights.
• Proven ability to produce data-driven deliverables that inform strategic decision-making.
• Excellent written and verbal communication skills
  Knowledge of fraud and legal rights and expectations is considered an asset. A combination of education and experience may be considered.

YOUR ABILITIES

• Proficient knowledge about benefit administration to understand complexities in patterns to identify and investigate.
• Previous audit and/or investigation experience within the insurance industry, preferably within benefit administration
• Ability to analyze complex data sets to assess trends and identify opportunities to drive improvements
• PC skills and experience with various database search systems, internet, and social networking for investigative purposes.
• Ability to effectively and comfortably explore difficult and complex issues, and provide information, alternatives or suggestions.
• Good decision making and problem solving skills.
• Ability to work well in a fast paced environment, while effectively prioritizing workload.
• Strong communication skills and the ability to maintain a high attention to details.

• Facilitate the protection of the benefit plan from fraud and abuse of covered members and/or providers through advanced analytic reviews, routine claims monitoring and continued development of Benefit Assurance
• Work internally, and with external partners, to identify, assess, investigate, report on, and resolve areas of benefit fraud and abuse and errors in adjudication.
• Manage ASEBP’s tip line and internal contacts, collecting information for analysis and the formal investigation of claiming concerns.
• Implement detective and preventative controls aimed at minimizing the potential for fraud and abuse within ASEBP’s benefit plan.
• Conduct benefit claim review projects with covered members asking them to verify various aspects of their claimed products/services, tracking the responses, investigating when required and reporting accordingly.
• Support ASEBP’s fraud awareness initiatives internally and externally with covered member and employer group education on benefit fraud and abuse.