Investigations Analyst

Logistics: CGS (cgsadmin.com) - 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-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is ONSITE located at One Century Plaza, Nashville, TN.

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). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

What You'll Do:

• Analyzes and investigates provider data and delivers actionable insights to clients.

• Coordinates with management on unsupported findings and uses various systems to gather relevant provider data to ensure high-quality case completion.

• Processes adverse legal action cases, shares findings to customers, recommends provider status changes, and tracks case status to ensure timely government agency review and approval.

• Compiles provider data from various sources to summarize findings according to specific procedures, ensuring accurate reporting at the time of recommendation.

• Performs updates and changes to provider data within the case management system as instructed by internal/external customers.

• Participates in special projects for case file management, assists with testing system changes, and supports process improvements and cross-functional training as assigned.

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

• Required Education: Bachelor's degree

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

• Required Work Experience: None

• Required Software and tools: Microsoft Office

• Required Skills and Abilities:

  • Strong organizational, analytical or critical thinking skills.

  • Good judgment skills.

  • Excellent written and verbal communication skills.

  • Business math proficiency.

  • Ability to maintain effective working relationships. Ability to handle sensitive matters on a confidential basis.

We Prefer That You Have the Following:

• 2 years of healthcare administration.

• Highly adaptable and able to thrive in a fast-paced environment.

• Insurance experience

• Provider credentialing experience

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits 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.

Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications.

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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