Analyst, Senior Claims Research

Summary

Researches and resolves escalated complex and high profile claims issues. Serves as POC (point of contact) with various professional and facility / hospital providers in the research and resolution of all claims issues. May assist with escalated issues to include but not limited to provider enrollment medical review appeals and / or finance. Completes research efficiently and accurately to ensure the departmental goals are achieved.

Description

Location : This is afull-time (40 hours / week)role scheduledMonday through Friday based in atypical office environment. The position will befully onsite during the training period after you will transition into a fully remote schedule. You will work an 8-hour shift scheduled during our normal business hours of 8 : 00AM-5 : 00PM. This role is located 4101 Percival Rd. Columbia SC 29229.

What Youll Do :

Researches and resolves high profile claims issues. Ensures claims processing errors are corrected according to the appropriate provider reimbursement contract. May also research and resolve high profile issues including but not limited to provider enrollment medical review appeals and / or finance which may be received via written or telephone correspondence.

Serves as Point of Contact for various providers (professional and facility) to resolve all claims payment errors. Conducts weekly conference calls with assigned providers to ensure open communication pertaining to all current issues.

Communicates / educates providers on proper coding of claims claims filing pricing concerns contract questions benefit / system updates etc.

Determines if claims payment errors are the result of system issues. Troubleshoots and / or coordinates the resolution / correction of the system processing error.

Verifies disbursement requests to ensure the request is valid and appropriately documented. Researches rejected transition and paid status claims for validity and escalate as appropriate. Uses the various systems of the department / company to complete research.

Monitors inventory reports to ensure claims are resolved accordingly. Provides documentation as requested for audit purposes. May provide written or telephone correspondence to resolve claims issues.

To Qualify For This Position Youll Need The Following :

Required Education : High School Diploma or equivalent

Required Work Experience : 5 years of combined claims and provider service experience in a healthcare environment. 3 years of experience with claims systems (may be concurrent).

Required Skills and Abilities :

Comprehensive knowledge of claims payment policies and refund policies.

Working knowledge of related claims software systems.

Knowledge of medical terminology and coding as appropriate.

Strong analytical skills and the ability to retrieve and research automated reports.

Strong time management skills and adaptable to change.

Strong communication (verbal and written) communication skills.

Required Software and Other Tools : Standard office equipment.

We Prefer That You Have The Following :

Preferred Education : Bachelors degree-in Business Computer Science Healthcare Administration or a related field.

Preferred Skills and Abilities : Ability to run reports using pre-set data retrieval applications such as DB2 and EZTRIEVE Plus to obtain information for research and analysis.

Our Comprehensive Benefits Package Includes The Following :

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

What We Can Do for You :

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next :

After submitting your application our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

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 disabilitiesand 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 or call 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. Heres moreinformation .

Some states have required notifications. Heres more information.

Required Experience :

Senior IC

Key Skills

Spss,Data Collection,R,Stata,Research Experience,Statistical Software,Data Mining,Market Research,Visual Basic,Operations Research,SAS,Data Analysis Skills

Employment Type : Full-Time

Experience : years

Vacancy : 1