INSURANCE ANALYST

State of South Carolina; Columbia (SC); On-site; USD 38,000 - 52,000; Full time

Job summary

State of South Carolina's Workers’ Compensation Commission is seeking an entry-level Insurance Analyst to learn state processes and help verify coverage, respond to inquiries, and support claim files.

The role handles no-report files, assigns to compliance, verifies coverage for motions and orders, and assists with medical billing and coding tasks; strong analytical skills and MS Office proficiency are essential.

Qualifications

• High school diploma or equivalent required.
• Related work experience in processing workers' compensation claims preferred.
• Experience with medical billing and/or coding may be substituted by a bachelor’s degree.
• Strong analytical skills.
• Ability to work in a high-volume environment with attention to detail.
• Familiarity with workers’ compensation laws, regulations, policies, procedures, and organizational functions.
• Ability to communicate effectively and deal courteously with the public.
• Strong organizational and time management skills.
• Proficient in Microsoft Office.

Responsibilities

• Researching, verifying, and providing workers' compensation coverage information for claims filed without insurance coverage (“no report” files).
• Assigning "no report" files to compliance officers for investigation. Create and establish claim files for claims of insurance coverage.
• Verify coverage for additional parties added by Motions, Orders, and Amended Forms 50/52, etc.
• Generate Commission fines and answer incoming calls. Research and respond to inquiries from the public, staff, claimants, attorneys, healthcare providers, employee coverage issues, fines, and claim file status.
• Monitor electronic insurance reporting submissions and troubleshoot issues by responding to stakeholder inquiries regarding duplicate claims and rejected submissions. Collaborate with IT to resolve more technical program issues.
• Assists medical services policy analyst in the following areas: medical bill review; maintaining compliance with the MSD Bill Review software vendor; and ensuring accuracy in bill review for hospital and ambulatory payment manual for the purposes of formal bill disputes and TPA bill reviewer audits.

Job description

Join the South Carolina state government, where you can have a meaningful career, incomparable benefits, and a positive work-life balance! The Workers' Compensation Commission's mission is to provide an equitable and timely system of benefits to injured workers and employers in the most responsive, accurate, and reliable manner possible.

The WCC is looking for an eager person to fill an entry-level position. You will learn and gain experience in SC state government and workers' compensation. The South Carolina Workers’ Compensation Commission seeks a motivated, dedicated, and detail-oriented Insurance Analyst. This role involves analyzing and researching incoming claims to verify insurance coverage, creating files, assessing fines, and responding to stakeholder inquiries.

• Researching, verifying, and providing workers' compensation coverage information for claims filed without insurance coverage (“no report” files).


• Assigning \"no report\" files to compliance officers for investigation. Create and establish claim files for claims of insurance coverage.


• Verify coverage for additional parties added by Motions, Orders, and Amended Forms 50/52, etc.


• Generate Commission fines and answer incoming calls. Research and respond to inquiries from the public, staff, claimants, attorneys, healthcare providers, employee coverage issues, fines, and claim file status.


• Monitor electronic insurance reporting submissions and troubleshoot issues by responding to stakeholder inquiries regarding duplicate claims and rejected submissions. Collaborate with IT to resolve more technical program issues.


• Assists medical services policy analyst in the following areas: medical bill review; maintaining compliance with the MSD Bill Review software vendor; and ensuring accuracy in bill review for hospital and ambulatory payment manual for the purposes of formal bill disputes and TPA bill reviewer audits.

• A high school diploma and work experience that is directly related to processing workers' compensation insurance claims. Experience with medical billing and/or coding. A bachelor’s degree may be substituted for the related work experience.


• Strong analytical skills.


• Proven ability to work in a high-volume environment with attention to detail.


• Familiarity with workers’ compensation laws, regulations, policies, procedures, and organizational functions.


• Knowledge of applicable terminology and research practices.


• Ability to deal courteously and effectively with the public.


• Ability to communicate effectively.


• Strong organizational and time management skills.


• Proficient in Microsoft Office.

Certification or related experience regarding medical billing and/or coding. Experience with CMS’ policies and prospective payment system. A bachelor's degree may be substituted for related work experience.

The Workers’ Compensation Commission is committed to providing equal employment opportunities to all applicants and does not discriminate on the basis of race, color, religion, sex (including pregnancy, childbirth, or related medical conditions, including, but not limited, to lactation), national origin, age (40 or older), disability or genetic information.

The Workers’ Compensation Commission offers an exceptional benefits package for FTE positions that includes:

• Health, Dental, Vision, Long Term Disability, and Life Insurance for Employee, Spouse, and Children


• 15 days annual (vacation) leave per year


• 15 days sick leave per year


• 13 paid holidays


• State Retirement Plan and Deferred Compensation Programs