Analyst, Claims Research

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, operate one of the most sophisticated data processing centers in the Southeast, and have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers.

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.

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

Required Education: High School Diploma or equivalent

Required Work Experience: 3 years of experience processing claims in a healthcare environment. 2 years of experience with claims systems (can be concurrent).

Skills

• 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.
• Preferred Skills and Abilities:
  • 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.

Required Software and Other Tools: Standard office equipment.

Preferred Education: Bachelor's degree in Business, Computer Science, Healthcare Administration, or a related field.

Preferred Work Experience: 4 years of related experience if lacking degree.

Schedule

This position is full-time (40-hours/week) Monday-Friday from 7:30am-4:00pm in a typical office environment.

Location

This role is located on-site at 17 Technology Cir, Columbia, SC 29203.

Benefits

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• 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