Claims Adjudication Specialist II

Southcarolinablues; Columbia (SC); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Subsidized health plans

401K retirement plan with company 2x

Life Insurance

Paid Time Off

Job summary

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II to handle complex claims and routine inquiries in Columbia, SC. The role focuses on adjudication, reprocessing, and timely responses within standard guidelines.

The on-site position requires a high school diploma and 2 years of claims experience. Training will occur on-site; security clearance may be required; excellent communication and accuracy are essential.

Qualifications

• High School Diploma or equivalent.
• 2 years of experience processing, researching, and adjudicating claims.
• Strong organizational, analytical and judgment skills.
• Strong oral and written communication skills.
• Proficient in spelling, punctuation and grammar.
• Proficient in basic business math.

Responsibilities

• Examines and adjudicates complex or specialty claims according to regulations and guidelines.
• Enters claims into the system after verification of coding.
• Verifies that claims are keyed correctly and processed accurately.
• Corrects processing errors by reprocessing, adjusting or recouping claims.
• Researches and resolves claim edits and deferrals using policy references.
• Responds to routine correspondence and maintains spreadsheets as applicable.

Skills

Claims processing

Analytical thinking

Oral and written communication

Attention to detail

Basic business math

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II to handle complex claims and routine inquiries in Columbia, SC. The role focuses on adjudication, reprocessing, and timely responses within standard guidelines.

The on-site position requires a high school diploma and 2 years of claims experience. Training will occur on-site; security clearance may be required; excellent communication and accuracy are essential.