Claims Research Analyst Job at BlueCross BlueShield of South Carolina
Summary
As a member of the Operations Analyst Team, in this fast-paced environment, you will be responsible completing 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 position is full-time (40-hours/week) Monday-Friday work at home position. You will work an 8-hour shift. You will be issued all necessary supplies and equipment to perform your position responsibilities. This position is located at 8901 Farrow Road, Columbia, SC 29203.
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.
- 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’ll Need:
- 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).
- Division 6B - Experience must be in a Retail Pharmacy.
- 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.
- Division 6B - Either State or Nationally Certified Pharmacy Technician (CPhT)
- Standard office equipment
What we prefer:
- Previous experience working with pharmacy processing claims systems is preferred.
- Bachelor's degree-in Business, Computer Science, Healthcare Administration, or a related field
- 4 years-of related experience if lacking degree
- Knowledge of processing systems - RMMS, CES, AMMS, ITS, SOND, INFO, third party recovery display, and ALGS.
- Excellent written and verbal communication skills.
- Knowledge of electronic data processing systems and procedures and their integration with the users.
- Ability to run reports using pre-set data retrieval applications, such as DB2 and EZTRIEVE Plus, to obtain information for research and analysis.
What We can Do for You:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
- 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
- Wellness program and healthy lifestyle premium discount
- Tuition assistance
- Service recognition
- Employee Assistance
- Discounts to movies, theaters, zoos, theme parks and more
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.
Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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 e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
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