Analyst, Claims Research

BlueCross BlueShield of South Carolina•Columbia, SC

4d•Onsite

About The Position

The Analyst, Claims Research completes research efficiently and accurately to help prevent claims from aging, erroneous disbursements, and claims processing incorrectly. The role also assists with special projects as needed. It is a full-time, 40-hour-per-week, on-site position in a typical office environment at 17 Technology Cir, Columbia, SC 29203, working Monday through Friday from 7:30 a.m. to 4:00 p.m.

Requirements

High school diploma or equivalent.
Three years of experience processing claims in a healthcare environment.
Two years of experience with claims systems; experience may be concurrent with the claims-processing experience.
In-depth knowledge of claims payment and refund policies.
Knowledge of related claims software systems.
Knowledge of medical terminology and applicable coding, including CPT IV, ICD 9 diagnosis codes, or NCPDP coding.
Good analytical skills and the ability to retrieve and research automated reports.
Good time-management skills and adaptability to change.
Good written and verbal communication skills.

Nice To Haves

Bachelor's degree in Business, Computer Science, Healthcare Administration, or a related field.
Four years of related experience if lacking a degree.
Knowledge of processing systems including 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 users.
Ability to run reports using preset data retrieval applications such as DB2 and EZTRIEVE Plus for research and analysis.
Problem-solving skills.

Responsibilities

Verify disbursement requests to ensure they are valid and appropriately documented.
Research rejected, transition, and paid-status claims for validity, escalating issues as appropriate.
Use departmental and company systems to conduct research and develop knowledge of the claims system and its relationship to other systems.
May research claims to identify or validate fraud, waste, or abuse.
Monitor inventory reports to ensure claims are resolved appropriately.
Provide documentation as requested for audit purposes.
May provide written or telephone correspondence to resolve claims issues.
Research claims related to group billing or crediting, ensuring appropriate adjustments and that groups are credited or billed correctly.
Assist with special projects as needed.