Summary
As a Senior Claims Research Analyst, you will research and resolve escalated, complex, and high-profile claims issues. You will serve as POC (point of contact) with various professional and facility / hospital providers in the research and resolution of all claims issues. You may assist with escalated issues to include, but not be limited to, provider enrollment, medical review, and appeals and / or finance. You will also complete research efficiently and accurately to ensure the departmental goals are achieved.
Description
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!
Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.
Logistics:
This position is located onsite at 4101 Percival Rd. Columbia, SC, 29229. The hours are 8:00 a.m. – 5:00 p.m. Monday – Friday.
What You’ll Do:
- Research and resolve high profile claims issues.
- Ensure 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.
- Serve as Point of Contact for various providers (professional and facility) to resolve all claims payment errors.
- Conduct weekly conference calls with assigned providers to ensure open communication pertaining to all current issues.
- Communicate / educate providers on proper coding of claims, claims filing, pricing concerns, contract questions, benefit / system updates, etc.
- Determine if claims payment errors are the result of system issues.
- Troubleshoot and / or coordinate the resolution / correction of the system processing error.
- 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.
- 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.
To Qualify for This Position, You’ll Need:
- High School Diploma or equivalent.
- 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.
What We Prefer:
- One year of Lead Claims Processing experience.
What We can Do for You:
- 401(k) retirement savings plan with company match.
- Subsidized health plans and free vision coverage.
- Life insurance.
- Paid annual leave – the longer you work here, the more you earn.
- Nine paid holidays.
- On-site cafeterias and fitness centers in major locations.
- Wellness programs and healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
- Incentive Plan.
- Merit Plan.
- Continuing education funds for additional certifications and certification renewal.
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure your 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 be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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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 minorities, females, disabled individuals and 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 physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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.
