Claims Research Analyst
Claims Research Analyst
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Summary
This position completes research efficiently and accurately to ensure the departmental 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.
Description
Logistics:
This is a fulltime position located at our Columbia SC location. This position will require that you work onsite.
What You Will 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.
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 Will Need:
Required Education: High School Diploma or equivalent.
Required Work Experience: Threeyears of experience processing claims in a healthcare environment OR twoyears of experience with claims systems (can be concurrent).
We Prefer That You Have:
Two years third party liability experience.
Communicates appeals status.
Documents appeals resolution.
Processes appeals.
Supports second level reviews.
Works claims caseloads.
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.
- Onsite 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 you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.
We participate in EVerify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Heresmore information.
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 email or callext. 47480 with the nature of your request. We will decide regarding your request for reasonable accommodation on a casebycase basis.
We participate in EVerify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Heresmore information.
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 email or callext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a casebycase basis.
Required Experience:
IC
Employment Type
Full-Time
