Bluecross Blueshield of South Carolina - Columbia, SC
posted 2 months ago
As a Senior Claims Research Analyst at BlueCross BlueShield of South Carolina, you will play a crucial role in researching and resolving escalated, complex, and high-profile claims issues. This position requires you to serve as the primary point of contact (POC) for various professional and facility/hospital providers, ensuring that all claims issues are addressed efficiently and accurately. Your responsibilities will include assisting with escalated issues related to provider enrollment, medical review, appeals, and finance, all while striving to meet departmental goals. In this role, you will be expected to conduct thorough research to resolve high-profile claims issues, ensuring that any claims processing errors are corrected in accordance with the appropriate provider reimbursement contracts. You will also be responsible for communicating with providers to educate them on proper coding of claims, claims filing procedures, pricing concerns, and updates regarding benefits and systems. Additionally, you will troubleshoot and coordinate the resolution of any system processing errors that may arise. Your work will involve monitoring inventory reports to ensure timely resolution of claims, providing documentation for audit purposes, and maintaining open communication with assigned providers through weekly conference calls. This position is located onsite in Columbia, South Carolina, with standard working hours from 8:00 a.m. to 5:00 p.m., Monday through Friday.