Analyzes provider data, payments, performance trends, and outliers to support appropriate care and cost control. Documents departmental activity, develops benchmarks and corrective action plans, coordinates provider chart audits, monitors network performance, and communicates findings to internal teams. The role requires SQL, analytical skills, strong organization, and collaboration with clinical, provider relations, client experience, and development teams.
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
About UsSKYGEN 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.
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