Sr. Claims Research Analyst
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Job Location:
Columbia, IN - USA
Monthly Salary:
Not Disclosed
Posted on:
14 hours ago
Vacancies:
1 Vacancy
Job Summary
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
20% 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.20% 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.20% Communicates/educates providers on proper coding of claims claims filing pricing concerns contract questions benefit/system updates etc.20% Determines if claims payment errors are the result of system issues. Troubleshoots and/or coordinates the resolution/correction of the system processing error.10% Verifies disbursement requests to ensure the request is valid and appropriately documented. Researches rejected transition and paid status claims for validity and escalate as appropriate. Uses the various systems of the department/company to complete research.10% 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 Education: High School Diploma or equivalentRequired Work Experience: 5 years of combined claims and provider service experience in a healthcare environment. 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 Software and Tools: Standard office equipment. Preferred Education: Bachelors degree-in Business Computer Science Healthcare Administration or a related Skills and Abilities: Ability to run reports using pre-set data retrieval applications such as DB2 and EZTRIEVE Plus to obtain information for research and analysis. Work Environment: Typical office environment.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 disabilitiesand 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 or call 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. Heres moreinformation.
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Required Experience:
Senior IC
Key Skills
- Spss
- Data Collection
- R
- Stata
- Research Experience
- Statistical Software
- Data Mining
- Calculus
- Market Research
- Operations Research
- SAS
- Data Analysis Skills
About Company
You can’t reach new heights of performance unless you’re willing to invest in others. That people-first mantra has been our guiding light since we started in the Medicare business in 1965. Headquartered in Columbia, S.C., and with offices in Augusta, Ga.; Birmingham, Ala.; Camden, S.C ... View more
