Lead Refund Analyst

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<div class="isg-job-description“>Internal Reference Number: R1047794
Summary Functions as the work leader and/or specialist for the refund unit. Researches claims history to ensure patient eligibility and to determine if claims/procedure codes are accurate, duplicates and/or should result in recoupment.Description

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 8:00am-4:30pm. This role is located at on site at 4101 Percival Rd, Columbia, SC 29229.

What You’ll Do:

• Performs in-depth research from claims history. Handles reconciliation of refunds processed in the claims system, including disbursement. Responsible for the documenting and posting of special checks and invoices as needed.

• Responsible for leading or assisting staff with problem situations. Trains new and current staff to ensure consistent Application of established guidelines. May be responsible for distributing work and quality review of completed assignments. Updates and implements new desk procedures as needed.

• Leads communications with internal and external customers regarding the status of refunds, including negotiating the recoupment of refunds.

• Provides monthly reports for the area regarding the status of solicited and unsolicited refunds. Identifies issues and makes recommendations for improvements

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

• Required education:High School Diploma or equivalent

• Required Work experience:5 years of job related claims experience including 3 years of experience in the recouping and/or refunding of claims.

• Required Skills and Abilities:

• Strong negotiation, leadership and communication skills.

• Strong analytical, research and organizational skills.

• Strong knowledge of related processing support systems.

• Basic business math proficiency.

• Required Software and Tools:Microsoft Office.

We Prefer That You Have the Following:

• Preferred Education:Associate Degree-in Business Administration.

• Preferred Skills and Abilities:Strong presentation skills. Knowledge of mathematical or statistical concepts.

• Preferred Software and Other Tools:Proficient in word processing and spreadsheet applications.

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.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here’s moreinformation.

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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.

 

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