INSURANCE BENEFITS ANALYST 3 - 07202026-79402

Job Information

State of Tennessee Job Information

LOCATION OF (1) POSITION(S) TO BE FILLED: DEPARTMENT OF FINANCE & ADMINISTRATION, DAVIDSON COUNTY

This position is designed as Hybrid.

This position requires a criminal background check. Therefore, you may be required to provide information about your criminal history in order to be considered for this position.

Qualifications

Education and Experience: Bachelor's degree and two years of professional experience related to health insurance benefits, personnel work, or call center operations. Relevant experience may substitute for education up to four years. Two years as an Insurance Benefits Analyst may also qualify.

Overview

Under general supervision, the Insurance Benefits Analyst 3 serves in an advanced and/or lead role within the Benefits Administration team. This role is responsible for resolving complex eligibility, billing, and enrollment issues, conducting quality assurance audits, and guiding junior analysts to ensure consistent application of policies and procedures. This class differs from Insurance Benefits Analyst 2 in that an incumbent of the latter performs duties at the working level. This class differs from the Insurance Manager in that an incumbent of the latter supervises employees in this class.

Responsibilities

1. Investigate and resolve complex benefits cases including billing discrepancies and eligibility issues.
2. Serve as a subject matter expert and provide policy interpretation to internal teams and external stakeholders.
3. Conduct audits and quality assurance reviews to ensure compliance with plan documents and regulations.
4. Train, coach, and support team members in applying policies and customer service practices.
5. Coordinate with agencies, vendors, and benefit coordinators regarding escalated member concerns .
6. Coordinate with the courts and other governmental agencies to maintain compliance .
7. Generate and analyze reports to identify trends or system errors and recommend solutions.
8. Review and respond to administrative error exceptions and compliance issues.

Competencies (KSA's)

Competencies:
1. Directs Work
2. Manages Complexity
3. Interpersonal Savvy
4. Instills Trust
5. Organizational Savvy

Knowledges:
1. Knowledge of Health Benefits Administration
2. Knowledge of Microsoft Office
3. Financial Analysis
4. Customer and Personal Service
5. Methods and Techniques of Research, Analysis & Report Presentation

Skills:
1. Writing, Speaking and Reading Comprehension
2. Critical Thinking
3. Evaluating and Solving Complex Problems
4. Monitoring Processes and Performance
5. Active Listening and Learning

Abilities:
1. Written and Oral Comprehension
2. Retention of Policy and Procedural Information
3. Prioritize Tasks and Meet Deadlines
4. Deductive and Inductive Reasoning
5. Multitasking

Tools & Equipment

1. Microsoft Office
2. ERP Systems
3. Phone Systems
4. Standard Office Equipment