Claims Auditor

We are looking for an experienced Claims Auditor to join the BlueCross BlueShield of South Carolina team. This position requires a detail-oriented individual eager to ensure accuracy and integrity in our claims management process. The successful candidate should possess excellent analytical skills, a commitment to accuracy, and a customer service-oriented approach.The Claims Auditor will be responsible for assessing and verifying all submitted claims to ensure accuracy and compliance with established standards. The ideal candidate should have a comprehensive understanding of medical claims, medical coding, and the reimbursement process. The Claims Auditor should be able to spot discrepancies quickly and accurately and should possess strong problem-solving and communication skills.Required Qualifications: -At least three years of experience in the healthcare industry-Strong knowledge of medical coding and reimbursement processes-Excellent analytical and problem-solving skills-Excellent written and verbal communication skills-Ability to work in a fast-paced environment-Attention to detail and accuracy

Responsibilities of Claims Auditor:

• Review and verify accuracy of all medical claims and reimbursement processes
• Ensure compliance with established standards and regulations
• Identify discrepancies and errors in claims data quickly and accurately
• Compile and analyze claims data to uncover trends and irregularities
• Evaluate and investigate claims for potential fraud or abuse
• Provide feedback to management on areas for improvement
• Manage customer service inquiries and complaints in a timely manner
• Develop and implement strategies to reduce fraud and abuse in claims management
• Maintain up-to-date knowledge of healthcare industry trends and regulations
• Provide training and guidance to staff on claims management processes and procedures

BlueCross BlueShield of South Carolina is an Equal Opportunity Employer. We celebrate diversity and are committed to creating an inclusive environment for all employees. We do not discriminate based upon race, religion, color, national origin, sex, sexual orientation, gender identity, age, status as a protected veteran, status as an individual with a disability, or other applicable legally protected characteristics.

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