EGID Business Analyst
About The Position
The Business Analyst within the Internal Audit and Fiscal Analysis division of EGID plays a critical role in ensuring the integrity and accuracy of health, dental, and life claim audits. This position is responsible for conducting detailed audits, supporting data analysis projects, and collaborating with internal and external stakeholders to ensure compliance with plan design and benefits. The role also involves developing processes and procedures for efficient auditing, maintaining comprehensive reports, and providing expert support across various functions within the division to ensure accountability and optimize operations.
Requirements
- The Business Analyst requires a strong understanding of health, dental, and life claim auditing processes, expertise in data analytics, and effective communication skills for coordination with auditors and other stakeholders.
- Additionally, the role demands the ability to develop and implement processes for efficient audits and perform root cause analysis for claims adjustments.
- To be considered for this position your application must include a resume/CV with complete work and education history.
- Bachelor’s degree AND 2 years of professional auditing experience OR An equivalent combination of education and experience, substituting one year of professional or technical administrative experience in business or public administration for each year of the required education.
- NOTE: No substitution will be allowed for the required professional experience in a supervisor or administrative capacity.
Nice To Haves
- Bachelor’s degree in accounting, finance, or business.
- Certifications in any of the following areas: Certified Public Accountant (CPA), Certified Internal Auditor (CIA), Certified Fraud Examiner (CFE), Certified Information Systems Auditor (CISA), or Certified Government Auditing Professional (CGAP)
Responsibilities
- Audit health, dental, and life claims to ensure correct plan design, benefits, pricing, provider matching, etc. have been performed by the TPA.
- Utilize software to analyze large data sets for audit focus areas.
- Review processed claims to determine adherence to plan design, benefits, and pricing methodologies.
- Work with the TPAs to identify deficiencies in claims processing and appraise the adequacy of corrective measures taken.
- Appraise plan design and benefits to determine compliance with applicable state and federal coverage mandates.
- Use a tracking system or other tools to monitor audit activities and document work.
- Make written and oral presentations quantifying areas of focus and results.
- Develop and use data analytics methods to identify and report on plan healthcare cost trends.
- Develop processes and procedures to assist with effective and efficient claim audits.
- Develop and maintain reporting of audit results.
- Support claim appeals function, provider Network Management unit, TPA Management unit, and other areas within the division.
- Coordinate with external auditors for audits related to health and dental claims.
- Other duties as assigned.
Benefits
- Generous state-paid benefit allowance to offset insurance premiums.
- A wide selection of insurance plans with no pre-existing condition exclusions.
- Flexible Spending Accounts for health care and dependent care.
- Retirement Savings Plan with employer contributions.
- 11 paid holidays annually.
- 15 days of vacation and 15 days of sick leave in the first year.
- Longevity Bonus recognizing years of public service.
- Public Service Loan Forgiveness eligibility and tuition reimbursement.
- Wellness benefits, including an on-site gym and fitness center discounts.
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What This Job Offers
Job Type
Full-time
Career Level
Mid Level
Number of Employees
11-50 employees
