Claims Research & Validation Analyst

Southcarolinablues; Columbia (SC); Sur place; USD 48 000 - 70 000; Plein temps

Avantages offerts par ce poste

401k with company match

Paid Time Off

Education Assistance

Résumé du poste

BlueCross BlueShield of South Carolina is seeking an Analyst, Claims Research to conduct thorough analysis of claims data and ensure accurate, timely processing at on-site 17 Technology Cir, Columbia, SC. The role supports prevention of aging of claims and erroneous disbursements and participates in special projects as needed.

The candidate should have 3 years in healthcare claims processing, 2 years with claims systems, and strong knowledge of billing, refunds, and CPT/ICD/NCPDP coding.

Qualifications

• High School diploma or equivalent.
• 3 years of healthcare claims processing experience.
• 2 years of claims systems experience (e.g., RMMS, CES, AMMS).
• Knowledge of claims payment and refund policies.
• Knowledge of medical terminology and CPT/ICD/NCPDP codes.
• Strong analytical, communication, and time-management skills.

Responsabilités

• Verify disbursement requests for validity and appropriate documentation.
• Research rejected, transition, and paid status claims for validity and escalate as appropriate.
• Identify potential fraud, waste or abuse during claims research.
• Monitor inventory reports to ensure claims are resolved.
• Provide documentation for audit purposes and respond to inquiries.
• Research claims related to billing or crediting groups to ensure proper adjustments.

Connaissances

Claims research

Data analysis

Communication skills

Time management

Analytical skills

Formation

High School Diploma

Bachelor's degree (preferred)

Outils

DB2

EZTRIEVE Plus

RMMS

CES

AMMS

ITS

SOND

INFO

ALGS

Description du poste

BlueCross BlueShield of South Carolina is seeking an Analyst, Claims Research to conduct thorough analysis of claims data and ensure accurate, timely processing at on-site 17 Technology Cir, Columbia, SC. The role supports prevention of aging of claims and erroneous disbursements and participates in special projects as needed.

The candidate should have 3 years in healthcare claims processing, 2 years with claims systems, and strong knowledge of billing, refunds, and CPT/ICD/NCPDP coding.