South Carolina’s largest and oldest health insurance company
Claims Research Analyst
Location
United States
Posted
3 days ago
Salary
0
Seniority
Mid Level
No structured requirement data.
Job Description
Claims Research Analyst
BlueCross BlueShield of South Carolina
Role Description 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. Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm and will be fully remote. What You’ll 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. - Serves as a point of contact for various providers, professional and facility. - 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. Qualifications - High School Diploma or equivalent. - 3 years of experience processing claims in a healthcare environment. - 2 years of experience with claims systems (can be concurrent). Requirements - In-depth knowledge of claims payment policies and refund policies. - Knowledge of related claims software systems. - Knowledge of medical terminology, CPT IV coding, ICD 9 diagnosis codes, or NCPDP coding as appropriate. - Good analytical skills and the ability to retrieve and research automated reports. - Good time management skills and adaptable to change. - Good communication skills, both written and verbal. - Standard office equipment. Benefits - Subsidized health plans, dental and vision coverage. - 401k retirement savings plan with company match. - Life Insurance. - Paid Time Off (PTO). - On-site cafeterias and fitness centers in major locations. - Education Assistance. - Service Recognition. - National discounts to movies, theaters, zoos, theme parks and more.
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