BlueCross BlueShield of South Carolina · 1 day ago
Claims Research Analyst
Columbia, SC
Full-time
Hybrid
Mid Level
3+ years expBlueCross BlueShield of South Carolina is seeking a Claims Research Analyst to complete research efficiently and accurately to ensure departmental goals are met. The role involves verifying disbursement requests, monitoring inventory reports, and researching claims to prevent errors and ensure proper billing.
Financial ServicesHealth CareHealth InsuranceInsuranceMedical
Responsibilities
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
Qualification
Required
High School Diploma or equivalent
3 years of experience processing claims in a healthcare environment
2 years of experience with claims systems (can be concurrent)
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
Standard office equipment
Preferred
Bachelor's degree-in Business, Computer Science, Healthcare Administration, or a related field
4 years-of related experience if lacking degree
Knowledge of processing systems - RMMS, CES, AMMS, ITS, SOND, INFO, third party recovery display, and ALGS
Excellent written and verbal communication skills
Knowledge of electronic data processing systems and procedures and their integration with the users
Ability to run reports using pre-set data retrieval applications, such as DB2 and EZTRIEVE Plus, to obtain information for research and analysis
Benefits
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition
National discounts to movies, theaters, zoos, theme parks and more
Company
BlueCross BlueShield of South Carolina
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state.
10001+ employees
Funding
Current Stage
Late StageLeadership Team
April Richardson
Vice President and Chief Operating Officer of Companion Benefit Alternative
Alli McGary
Talent Acquisition Partner
Recent News
2025-09-13
UPSTATE BUSINESS JOURNAL
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