Claims Processing 1-24

BlueCross and BlueShield of South Carolina; Florence (SC); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Health and dental benefits

401k retirement plan with companyMatch

PTO

On-site cafeterias and fitness centers

Education assistance

Service recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking aClaims Processor to ensure accurate and timely processing of insurance claims at our Florence, SC site. This full-time, on-site role supports our commitment to delivering quality service to members and providers.

You will verify coding, resolve edits, and collaborate with internal teams to maintain complete and compliant claim records, with typical 8:00am-5:00pm hours Monday through Friday.

Qualifications

• High school diploma or equivalent required.
• At least 1 year of healthcare or insurance experience preferred.
• Proficiency with word processing and spreadsheet software; database skills help.
• Strong analytical, organizational and communication skills.

Responsibilities

• Researches and processes claims according to regulations, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes.
• Resolves system edits, audits and claims errors through research and use of approved references and investigative sources.
• Coordinates with internal departments to work edits and deferrals, updating patient and provider information as necessary.

Skills

Analytical skills

Organizational skills

Customer service

Oral communication

Written communication

Spelling and grammar

Judgment

Basic math

Education

High School Diploma or equivalent

Tools

Basic office software

Job description

Summary

Responsible for the accurate and timely processing of claims.

Description

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose

Responsible for the accurate and timely processing of claims.

Logistics

PGBA - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location

This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm. This role is located on-site at 200 N Dozier Blvd., Florence, SC 29501.

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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

Sponsorship

This position is not eligible for sponsorship now or in the future.

What You'll Do

• Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes.
• Resolves system edits, audits and claims errors through research and use of approved references and investigative sources.
• Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.

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

Required Education: High School Diploma or equivalent

• Strong analytical, organizational and customer service skills.
• Strong oral and written communication skills.
• Proficient spelling, punctuation and grammar skills.
• Good judgment skills.
• Basic business math skills.

Required Software and Tools: Basic office equipment.

We Prefer That You Have the Following

Preferred Work Experience: 1 year-of experience in a healthcare or insurance environment.

• Ability to use complex mathematical calculations.

Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. Proficient in database software.

Our Comprehensive Benefits Package Includes the Following

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

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 disabilities and 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 impo