Claims Research Analyst

Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm and will be fully remote.

What You’ll Do:

• 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.

• Serves as a point of contact for various providers, professional and facility. 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.

To Qualify For This Position, You'll Need The Following:

• 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).

• Required Skills and Abilities:

• 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.

• Required Software and Other Tools: Standard office equipment.

We Prefer That You Have The Following:

• 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.

• 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

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 disabilities and 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 [email protected] or call 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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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