Claims Policy Analyst II

Logistics: Palmetto GBA - one of BlueCross BlueShield's 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-4:30PM. 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.

• SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). To comply with the McNamara-O'Hara Service Contract Act (SCA), employees must enroll in our health insurance even if they have other health insurance. Employees will receive supplemental pay for health insurance until they are enrolled in our health insurance, first of the month following 28 days after the hire date.

What You'll Do:

• Reviews, analyzes, researches and interprets all directives and/or claims system update releases. Identifies all changes needed and prepares and submits claims system maintenance request. Verifies and approves changes to processing procedures and claims system. May add codes to the system and verify maintenance and testing. May serve as liaison between management and less senior staff on management reports, and implementation of documents and mandates. Approves changes to the on-line claims processing procedure manual and communicate claim processing changes to other areas of relevant operation. May develop and issue examining memos/help screens and claims processing instructions and provide education on all claims system changes.

• Acts as a functional system and claims policy subject matter expert for the area. Researches and responds to inquiries and/or provider escalations. Assists the Provider Call Center when subject matter expert is needed to resolve the caller's inquiry. Assists less senior staff, management and other areas of the operation. Function as lead for mandates and projects while guiding less senior analysts for departmental management. Maintains and monitors existing edits/audits and requests maintenance updates as needed. Analyzes and responds to assigned Claims.

• Compiles and reviews monthly/quarterly reports and notifies management of any outstanding issues or problems that could affect critical business processes.

• Reviews items for management, identifies discrepancies, gathers explanatory information and makes recommendation on necessary actions or response.

• Directs less senior analysts and create action plan to follow protocol to ensure compliance in annual updates. May build new rules and/or add new codes to the claims system, delete invalid codes from the claims system, and educate the staff on changes.

• Assist manager with assignments and special projects.

To Qualify for This Position, You'll Need the Following:

• Required Education: Bachelor's

• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience

• Required Work Experience: 3 years of industry specific work experience. 2 years of project administration experience.

• Required Skills and Abilities:

• Excellent technical skills including knowledge of claims system.

• Ability to lead and direct others on assignments.

• Skilled at project management.

• Ability to persuade, negotiate or influence.

• Strong organization, analytical and decision-making skills.

• Good personal computer skills.

• Thorough understanding of required legislation, guidelines and regulations.

• Ability to handle confidential or sensitive information with discretion.

• Required Software and Other Tools: Microsoft Office.

We Prefer That You Have the Following:

• Knowledge of medical terminology.

• Knowledge of Medicare Part B regulations/policies/instructions/provisions.

• Working knowledge of Microsoft Excel, PowerPoint, or other spreadsheet/database software.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment.

• 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

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

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 disabilitiesand 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.comor 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.

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