• Independently perform audits and analysis of State Group claims utilizing standard audit practices • Ability to research and analyze provider contracts to ensure accurate claims processing • Identify incorrect application of State Group benefits, and analyze Benefit Narrative Viewer data • Provide education and training to staff and management on defects, updates and improvements to guidelines, processes and procedures • Analyze claims data to detect trends, patterns and system issues • Research and resolve claims issues, working with internal stakeholders as needed • Identify, recommend, implement and monitor processes, procedures, system enhancements and/or program improvements. • Ensure State claims are paid in accordance with State benefits, provider contracts, and Florida Blue policies • Maintain reports and dashboards to track audit findings, trends, and resolution progress • Develop and implement audit plans, tools, and procedures to ensure thorough and efficient audits • Document and communicate audit findings, conclusions, and recommendations to management and other stakeholders