Analyst, Appeals

Description

Logistics: Palmetto GBA, one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This is a full-time position (40 hours per week), working Monday through Friday in a fully remote environment. You will work an 8-hour shift scheduled within our normal business hours of 8:00 a.m. to 4:30 p.m. Eastern Time. Training will last approximately 8 to 12 weeks. After successfully completing training, you will have the option to begin your 8-hour shift as early as 6:00 a.m. Eastern Time.

To Qualify For This Position, You'll Need The Following Required Education

• Associate's in a job related field
• Graduate of Accredited School of Nursing

Required Work Experience

• 2 years clinical experience plus 1 year utilization/medical review, quality assurance, or home health, OR, 3 years clinical
• FOR PALMETTO GBA (CO. 033) ONLY: 2 years clinical experience plus 2 years utilization/medical review, quality assurance, or home health experience or a combination of experience in clinical, utilization/medical review, quality assurance or home health experience totaling four years.

Required Skills And Abilities

• Working knowledge of word processing software
• Ability to work independently, prioritize effectively, and make sound decisions
• Working knowledge of managed care and various forms of health care delivery systems
• Strong clinical experience to include home health, rehabilitation, and/or broad medical surgical experience
• Knowledge of specific criteria/protocol sets and the use of the same
• Good judgment skills
• Demonstrated customer service, organizational, oral and written communication skills
• Ability to persuade, negotiate, or influence others
• Analytical or critical thinking skills
• Ability to handle confidential or sensitive information with discretion

Required Software and Tools

• Microsoft Office

Required License and Certificate

• An active, unrestricted RN license from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC).

We Prefer That You Have The Following

• 5 years of clinical experience
• Experience in medical claims processing, appeals, or coding
• Strong computer proficiency, with the ability to navigate multiple systems and work across dual screens efficiently
• Intermediate-level Excel skills
• Experience creating letters and documents by reviewing appeals and extracting information with a high degree of accuracy; updates departmental documents as needed.

What We Can Do For You

• Comprehensive Benefits Package Includes:
• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.