Senior Claims Research Analyst

Claims Resolution Specialist

Researches and resolves escalated, complex, and high profile claims issues. Serves as 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.

Location : This position is full-time (40-hours / week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours 8am-6pm. Type office environment. Travel required as necessary. This role is located at on site at 4101 Percival Road, Columbia SC.

What You'll 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. Research 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, You'll Need the Following :

We Prefer You Have the Following :

Our Comprehensive Benefits Package Includes the Following :

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for 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. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the required qualifications.