Claims Research Analyst

Overview

This position completes research efficiently and accurately to ensure the department 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.

Location:

This position is full-time (40-hours/week) Monday-Friday in a typical office environment with the potential to work Hybrid after successful completion of a 90-day training period. You will work an 8-hour shift scheduled during our normal business hours of 9:00AM-5:30PM. This role is located at 17 Technology Circle Columbia, SC 29203.

• 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 related to billing or crediting groups. Ensure proper adjustments are made and groups receive credit or are billed appropriately.

• 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)
• 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 adaptability to change
• Good communication skills, both written and verbal
• Standard office equipment familiarity

• 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
• 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

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
• PTO
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

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.

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.

Blue Cross Blue Shield 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…