**Repost Please do not reapply** INSURANCE ANALYST

State of South Carolina; Columbia (SC); On-site; USD 45,000 - 60,000; Full time

Benefits offered by this job

Health insurance

Dental insurance

Vision insurance

13 paid holidays

Retirement plan

Job summary

The South Carolina Workers’ Compensation Commission is hiring a claims analyst to research and verify coverage information for no report files, assign cases to compliance officers, and respond to public inquiries. The role supports medical billing review and ensures accurate bill dispute handling, with emphasis on compliance and customer service in a high-volume environment.

The position offers comprehensive state benefits and a stable government career path, with opportunities for professional

Qualifications

• High school diploma or related work experience in processing workers' compensation claims.
• Experience with medical billing and/or coding.
• 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.

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.
• 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.

Skills

Analytical skills

Microsoft Office proficiency

Communication skills

Time management

Attention to detail

Education

High school diploma

Bachelor’s degree substitution allowed

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.

Job 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.

Minimum And Additional Requirements

• 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.

Preferred Qualifications

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.

Additional Comments

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

Benefits For State Employees

The state of South Carolina offers eligible employees generous benefits, including health and dental insurance; retirement and savings plan options; and paid vacation and sick leave. Plus, work-life balance programs such as telecommuting and flexible work schedules are available to employees of some state agencies.

Insurance Benefits

Eligible employees may enroll in health insurance, which includes prescription coverage and wellness benefits. Other available insurance benefits include dental, vision, term life insurance, long term disability and flexible spending accounts for health and child care expenses.

Retirement Benefits

State employees are also offered retirement plan options, including defined benefit and defined contribution plans. Additionally, eligible employees may elect to participate in the South Carolina Deferred Compensation Program, which is a voluntary, supplemental retirement savings plan offering 401(k) and 457 plan options.

Workplace Benefits

State employees may also be eligible for other benefits, including tuition assistance; holiday, annual and sick leave; and discounts on purchases, travel and more.

Note:

The benefits above are available to most state employees, with the exception of those in temporary positions. Employees in temporary grant and time-limited positions may be eligible for all, some or none of these benefits as benefits are associated with each position type. For these positions, contact the hiring agency to determine what benefits may be available.