Medical Affairs Coordinator

About the Role

BlueCross BlueShield of South Carolina is seeking a Clinical Policy Analyst to support the Local Coverage Determination (LCD) process. In this role, you will apply clinical expertise and judgment to develop and maintain LCDs, create educational resources for providers, and help reduce claim errors for Medicare and other contracts. This is a remote, full-time position (M–F, 8am–5pm) requiring U.S. citizenship and the ability to obtain a government security clearance.

What You’ll Do

• Provide clinical expertise and research to develop and maintain Local Coverage Determinations (LCDs).

• Educate providers and internal teams on LCDs, coding, and reimbursement guidelines.

• Communicate across departments to ensure compliance with Medicare and contract requirements.

• Review and analyze claims-related issues to support error reduction efforts.

• Serve as a reviewer to determine inter-rater reliability.

What You Need

Required:

• Bachelor’s degree in a related field OR Associate’s degree in Nursing with an active RN license.

• 5+ years of clinical experience in medical insurance, managed care, case management, or claims management.

• Strong knowledge of managed care/medical claims payment policies.

• Excellent communication, analytical, negotiation, and customer service skills.

• Proficiency in Microsoft Office (Word, Excel, PowerPoint).

• Active, unrestricted RN license (or Compact RN license).

• U.S. citizenship (for security clearance eligibility).

Preferred:

• Bachelor’s degree in Nursing.

• 7+ years of relevant clinical experience.

• Knowledge of government healthcare programs, regulations, and contract laws.

• Experience with Microsoft Access, DB2, Easytrieve, or database software.

• Professional certifications such as HIAA, LOMA, ACLI, MPH, or MHA.

Benefits We Offer

• 401(k) retirement savings plan with company match.

• Subsidized health plans + free vision coverage.

• Paid time off, nine paid holidays, and paid annual leave (increasing with tenure).

• Life insurance and wellness programs with lifestyle premium discounts.

• Tuition assistance and continuing education funds.

• Incentive and merit plans.

• On-site cafeterias and fitness centers in major locations.

What to Expect

Our recruiting team will review your application to ensure qualifications are met. Selected candidates may be invited to a phone interview, followed by management interviews for those demonstrating preferred qualifications.

Equal Opportunity Employer

BlueCross BlueShield of South Carolina is an Equal Opportunity Employer. We do not discriminate based on age, race, color, national origin, sex, religion, disability, veteran status, sexual orientation, gender identity, or other legally protected status. As a federal contractor, we maintain affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans.