Senior Claims Research Analyst Position Available In Richland, South Carolina
Tallo's Job Summary: The Senior Claims Research Analyst position is a full-time role located in Columbia, SC, requiring on-site work. Responsibilities include researching and resolving high-profile claims issues, ensuring accurate claims processing, and serving as a point of contact for providers. Qualifications include 5 years of healthcare claims experience or 3 years of claims systems experience. Benefits include retirement savings, health plans, and paid leave.
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 full-time position (40 HPW), and is located at our Columbia, SC location. This position will require that you work on-site, full-time.
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. To Qualify for
This Position, You Will Need:
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:
Bachelor’s degree-in Business, Computer Science, Healthcare Administration, or a related field.
Preferred 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. 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. On-site 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 E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Some states have required notifications. Here’s more 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 e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, ext. 47480 with the nature of your request. We will decide 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’s more 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 e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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. If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to Join Our Talent Community by submitting your resume and contact information and we will reach out if we find a good fit. Welcome Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. Join Us If you’re ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!
