SUMMARY

We have a job opening for the position of Claims Research Analyst at PGBA one of BlueCross BlueShield’s of South Carolina subsidiary companies. The Claims Research Analyst position completes research efficiently and accurately to ensure the departmental goals to prevent aging of claims and erroneous disbursements or claims from processing incorrectly. This position also assists in any special projects that may arise.
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

DESCRIPTION

Logistics: PGBA – one of BlueCross BlueShield’s of South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 17 Technology Circle, Columbia, SC 29203.

TO QUALIFY FOR THIS POSITION, YOU’LL NEED THE FOLLOWING:

• Required Education: High School Diploma or equivalent.
• Required Work Experience: 3 years of experience processing claims in a healthcare environment. 2 years of experience with claims systems (can be concurrent).
• Required Skills and Abilities: In-depth knowledge of claims payment policies and refund policies. Knowledge of related claims software systems. Knowledge of medical terminology, CPT IV coding, ICD 9 diagnosis codes, or NCPDP coding as appropriate. Good analytical skills and the ability to retrieve and research automated reports. Good time management skills and adaptable to change. Good communication skills, both written and verbal.
• Required Software and Tools: Basic office equipment

EQUAL EMPLOYMENT OPPORTUNITY STATEMENT

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here’s more information .
Some states have required notifications. Here’s more information

• Verify disbursement requests to ensure the request is valid and appropriately documented. Research rejected, transition, and paid status claims for validity and escalate as appropriate. Use the various systems of the department/company to complete research and gain sufficient knowledge of the claims system and how it relates to other systems.
• May research claims to identify or validate fraud, waste or abuse.
• Monitor inventory reports to ensure claims are resolved accordingly. Provide documentation as requested for audit purposes. May provide written or telephone correspondence to resolve claims issues.Research claims as related to billing or crediting groups. Research claims to ensure the proper adjustments are made and groups receive credit or are billed appropriately.