INSURANCE ANALYST

State-of-South-Carolina; South Carolina; On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health, Dental, Vision Insurance

Long Term Disability

Life Insurance for Employee, Spouse, &

Children

15 days annual leave

15 days sick leave

13 paid holidays

State Retirement Plan

Deferred Compensation Programs

Job summary

The South Carolina Workers’ Compensation Commission seeks an entry-level Insurance Analyst to learn SC state government procedures and workers' compensation processes. You will analyze and research claims to verify insurance coverage, create files, assess fines, and respond to stakeholder inquiries.

Responsibilities include handling no-report files, assigning cases to officers, verifying coverage for parties named in motions, and coordinating with IT on reporting issues.

Qualifications

• High school diploma required; related work experience preferred.
• Strong analytical skills with attention to detail are essential.
• Ability to communicate effectively and work courteously with the public.
• Excellent organizational and time-management abilities are required.
• Proficiency in Microsoft Office and basic research practices are necessary.

Responsibilities

• Research and verify workers' compensation coverage information for claims without insurance coverage (no report files).
• Assign no report files to compliance officers for investigation and create claim files for coverage claims.
• Verify coverage for parties added by motions, orders, and amended forms 50/52.
• Generate fines and respond to inquiries from the public, staff, claimants, and attorneys.
• Monitor electronic reporting submissions and troubleshoot issues in collaboration with IT.

Skills

Strong analytical skills

Attention to detail

Excellent communication skills

Organizational skills

Time management skills

Education

High school diploma

Bachelor’s degree may be substituted for related work experience

Tools

Microsoft Office

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