Claims Research Analyst

BlueCross BlueShield of South Carolina•Columbia, SC

21h•Hybrid

About The Position

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. Description Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment with the potential to work Hybrid after successful completion of a 90-day training period. You will work an 8-hour shift scheduled during our normal business hours of 9:00AM-5:30PM. This role is located at 17 Technology Circle Columbia, SC 29203.

Requirements

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).
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.

Nice To Haves

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.

Responsibilities

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.