Senior Claims Research Analyst
Senior Claims Research Analyst
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Not Disclosed
Salary Not Disclosed
1 Vacancy
Job Description
Summary
Researches and resolves escalated complex and high profile claims issues. Serves as POC (point of contact) with various professional and facility/hospital providers in the research and resolution of all claims issues. May assist with escalated issues to include but not limited to provider enrollment medical review appeals and/or finance. Completes research efficiently and accurately to ensure the departmental goals are achieved.
Description
Logistics:
This is a fulltime position 40MPH) and will require to be onsite at our Columbia SC location.
What You Will Do:
Researches and resolves high profile claims issues.
Ensures 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.
Serves as Point of Contact for various providers (professional and facility) to resolve all claims payment errors. Conducts weekly conference calls with assigned providers to ensure open communication pertaining to all current issues.
Communicates/educates providers on proper coding of claims claims filing pricing concerns contract questions benefit/system updates etc.
Determines if claims payment errors are the result of system issues. Troubleshoots and/or coordinates the resolution/correction of the system processing error.
Verifies 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.
Monitors inventory reports to ensure claims are resolved accordingly. Provides documentation as requested for audit purposes.
May provide written or telephone correspondence to resolve claims issues.
We Will Require You Have:
Required Education: High School Diploma or equivalent.
Required Work Experience: 5 years of combined claims and provider service experience in a healthcare environment or 3 years of experience with claims systems (may be concurrent).
Required Skills and Abilities: 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.
Required Software and Tools: Standard office equipment.
We Prefer That You Have:
Preferred Education: Bachelors degreein Business Computer Science Healthcare Administration or a related field.
Preferred Skills and Abilities: Ability to run reports using preset data retrieval applications such as DB2 and EZTRIEVE Plus to obtain information for research and analysis.
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:
Senior IC
Employment Type
Full-Time
