Senior Claims Research Analyst

Logistics:

• This is a full time (40 HPW) position, and our ideal candidate will work on-site at our Columbia, SC location.

What You'll 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. Researches rejected, transition, and paid status claims for validity and escalate as appropriate. Uses 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.

To Qualify for This Position, You'll Need the Following:

• 5 years of combined claims and provider service experience in a healthcare environment.
• 3 years of experience with claims systems (may be concurrent).
• Required Education: High School Diploma or equivalent

We Prefer That You Have the Following:

• ITS Claims Processing
• Pharmacy Claims Experience
• Skills and Abilities: Communicates appeals status. Documents appeal. Processes appeals. Supports second level reviews. Works claims caseloads

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits on 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.
• Education Assistance.
• Service Recognition.
• National discounts to movies, theaters, zoos, theme parks and more! .

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have an opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Except 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 E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here'smore 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 individuals with disabilities and 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 mycareer.help@bcbsasc.comor call 800-288-2277, ext.47480 with the nature of your request. We will make a decision 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.

Some states have required notifications. Here'smore 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 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 mycareer.help@bcbssc.comor call 800-288-2227, 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. Here's moreinformation.

Some states have required notifications. Here's more information.