Insurance Claims & Compliance 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

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.