Claims Processing Specialist I

Pgba, Llc; Florence (SC); Hybrid; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health plans

Dental & vision coverage

401k with company match

PTO

On-site cafeterias & fitness centers

Education assistance

Service recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina seeks a Claims Processor I to ensure accurate, timely processing of medical claims at our Florence, SC site. You will verify procedure and diagnosis codes, resolve processing edits, and collaborate with internal teams to maintain correct patient and provider information.

The role requires a high school diploma, strong analytical and communication skills, basic business math, and the ability to obtain security clearance as a U.S. citizen.

Qualifications

• Researches and processes claims according to business regulations, standards and processing guidelines.
• Resolves system edits, audits and claim errors through investigation and approved references.
• Coordinates with internal departments to update patient IDs, other health insurance and provider data.

Responsibilities

• Researches and processes claims according to business regulation, internal standards and processing guidelines.
• Verifies coding of procedure and diagnosis codes.
• Coordinates with internal departments to work edits and deferrals and update patient/provider data.

Skills

Analytical skills

Organizational skills

Customer service

Oral communication

Written communication

Judgment

Basic math

Spelling/grammar

Education

High School Diploma or equivalent

Tools

Word processing

Spreadsheets

Database software

Job description

BlueCross BlueShield of South Carolina seeks a Claims Processor I to ensure accurate, timely processing of medical claims at our Florence, SC site. You will verify procedure and diagnosis codes, resolve processing edits, and collaborate with internal teams to maintain correct patient and provider information.

The role requires a high school diploma, strong analytical and communication skills, basic business math, and the ability to obtain security clearance as a U.S. citizen.