Summary
 

We are currently hiring for a Claims Policy Analyst II to join BlueCross BlueShield of South Carolina. In this role as a Claims Policy Analyst II, you will interprets all directives and policies to establish processing guidelines for area of expertise. Works with the systems department to create edits/audits and other related changes for the claims system. Maintains and monitors existing edits/audits and requests all maintenance for the claims system. Position requires specific area knowledge and may be seen as the subject matter expert.

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.

Description
 

Logistics

This position is full time (40 hours/week) Monday-Friday and will be located in Columbia, SC.

What You'll Do:

• Reviews, analyzes, researches and interprets all directives and/or claims system update releases.
• Identifies all changes needed and prepares and submits claims system maintenance request.
• Verifies and approves changes to processing procedures and claims system.
• May add codes to the system and verify maintenance and testing.
• May serve as liaison between management and less senior staff on management reports, and implementation of documents and mandates.
• Approves changes to the on-line claims processing procedure manual and communicate claim processing changes to other areas of relevant operation.
• May develop and issue examining memos/help screens and claims processing instructions and provide education on all claims system changes.
• Acts as a functional system and claims policy subject matter expert for the area.
• Researches and responds to inquiries and/or provider escalations.
• Assists the Provider Call Center when subject matter expert is needed to resolve the caller's inquiry.
• Assists less senior staff, management and other areas of the operation.
• Function as lead for mandates and projects while guiding less senior analysts for departmental management.
• Maintains and monitors existing edits/audits and requests maintenance updates as needed.
• Analyzes and responds to assigned Claims.
• Compiles and reviews monthly/quarterly reports and notifies management of any outstanding issues or problems that could affect critical business processes.
• Reviews items for management, identifies discrepancies, gathers explanatory information and makes recommendation on necessary actions or response.
• Directs less senior analysts and create action plan to follow protocol to ensure compliance in annual updates.
• May build new rules and/or add new codes to the claims system, delete invalid codes from the claims system, and educate the staff on changes.
• Assist manager with assignments and special projects.

To Qualify for This Position, You'll Need:

• Bachelor’s Degree.
• Four years job related work experience or Associate's and two