Analyst, Claims Policy II

Summary
 Interprets all directives and policies to establish processing guidelines for area of expertise. Works with the systems department to create edits/audits and other related changes for the claims system. Maintains and monitors existing edits/audits and requests all maintenance for the claims system. Position requires specific area knowledge and may be seen as the subject matter expert.
Description
 

What you Will 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 those that fall under 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.

What Is Required:

• Bachelor's Degree or Equivalency:
• 4 years job related work experience or
• Associate's and 2 years job related work experience.
• 3 years of industry specific work experience. 2 years of project administration experience.
• 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.
• Proficient in Microsoft Office Products, specifically with Excel and Word documents.
• Ability to travel as needed.

We Prefer You To Have:

• Proficiency with Microsoft Office Products, Excel and Word.
• Candidates will need to work with all aspects of Excel, including creating, reviewing, and explanation of said documents.
• Advanced skills in excel that include data entry, simple formatting, chart creation, cell formatting, data sorting and filtering.
• Pivot table creation and manipulation, complex formula creation and troubleshooting experience.
• Macros and VBA Visual Basic for application scripting, data analysis, and modeling.
• Experience with Power Querry and power Pivot usage.
• Pivot table experience.

What Blue Can Do For You:

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid Annual Leave (the longer you work here, the more you earn).
• Nine Paid Holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness Programs and a Healthy Lifestyle Premium Discount.
• Tuition Assistance.
• Service Recognition.
• Realistic career advancement opportunities.

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.

Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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.

Some states have required notifications. Here's more information. 

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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.