Claims & Appeals Advocate II

ourhrconnect; Columbia (SC); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health insurance

401K retirement savings with company-m

Paid Time Off

Employee assistance

Job summary

BlueCross BlueShield of South Carolina, through its PGBA subsidiary, seeks a claims processor for on-site work in Columbia. You will respond to inquiries about claims/appeals, identify processing errors, and execute adjustments and reprocessing actions.

You will verify coding and ensure quality and production standards in a full-time 40-hour week. Requirements include a high school diploma or equivalent, 1 year of claims/appeals processing or related experience (or a bachelor’s degree), and

Qualifications

• High School Diploma or equivalent required.
• 1 year experience in claims/appeals processing or related support, or a bachelor's degree in lieu of experience.
• Strong communication skills and ability to handle confidential information with discretion.
• Proficiency with Microsoft Office applications.

Responsibilities

• Respond to routine written and telephone inquiries regarding claims or appeals.
• Identify incorrectly processed claims and complete adjustments and reprocessing actions.
• Document inquiries accurately and ensure timeliness and quality.
• Process claims and non-medical appeals per regulations and guidelines.

Skills

Verbal and written communication

Customer service

Spelling punctuation grammar

Business math

Confidential information handling

Education

High school diploma or equivalent

Associate degree preferred

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina, through its PGBA subsidiary, seeks a claims processor for on-site work in Columbia. You will respond to inquiries about claims/appeals, identify processing errors, and execute adjustments and reprocessing actions.

You will verify coding and ensure quality and production standards in a full-time 40-hour week. Requirements include a high school diploma or equivalent, 1 year of claims/appeals processing or related experience (or a bachelor’s degree), and