Analyst, Claims Research

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.
• 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.
• 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.
• Previous experience working with pharmacy processing claims systems is preferred.
• 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)

We PreferYou to Have:

• 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 Blue Can Do for You:

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

Our comprehensive benefits package includes:

• 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 you meet the qualifications. This may include a brief telephone interview or email communication with our 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.comor 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.

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.