Summary
 

As a Senior Research Claims 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 Lea