Claims Policy Analyst II - Palmetto GBA

Description

Why should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Why should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

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.

Palmetto GBA – one of Blue Cross Blue Shield's South Carolina subsidiary companies.

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.

Blue Cross Blue Shield 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.

• 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…