Analyst, Claims Research

About the role

This position completes research efficiently and accurately to ensure the departmental goals to prevent aging of claims and erroneous disbursements or claims from processing incorrectly. This position also assists in any special projects that may arise. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Responsibilities

• Verify disbursement requests to ensure the request is valid and appropriately documented.
• Research rejected, transition, and paid status claims for validity and escalate as appropriate.
• Use the various systems of the department/company to complete research and gain sufficient knowledge of the claims system and how it relates to other systems.
• May research claims to identify or validate fraud, waste or abuse.
• Monitor inventory reports to ensure claims are resolved accordingly.
• Provide documentation as requested for audit purposes.
• May provide written or telephone correspondence to resolve claims issues.
• Research claims as related to billing or crediting groups.
• Research claims to ensure the proper adjustments are made and groups receive credit or are billed appropriately.

Requirements

• High School Diploma or equivalent.
• 3 years of experience processing claims in a healthcare environment.
• 2 years of experience with claims systems (can be concurrent).
• In-depth knowledge of claims payment policies and refund policies.
• Knowledge of related claims software systems.
• Knowledge of medical terminology, CPT IV coding, ICD 9 diagnosis codes, or NCPDP coding as appropriate.
• Good analytical skills and the ability to retrieve and research automated reports.
• Good time management skills and adaptable to change.
• Good communication skills, both written and verbal.
• Standard office equipment.

Qualifications

• Bachelor's degree in Business, Computer Science, Healthcare Administration, or a related field.
• 4 years of related experience if lacking a degree.
• Knowledge of processing systems - RMMS, CES, AMMS, ITS, SOND, INFO, third party recovery display, and ALGS.
• Excellent written and verbal communication skills.
• Knowledge of electronic data processing systems and procedures and their integration with the users.
• Ability to run reports using pre-set data retrieval applications, such as DB2 and EZTRIEVE Plus, to obtain information for research and analysis.
• Problem-solving skills.

Benefits

• Subsidized health plans, dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (