Claims Processor I

Pgba, Llc; Columbia, Northern (SC, KY); Hybrid; USD 40,000 - 62,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

PTO

Job summary

PGBA, LLC in Columbia, SC is seeking a detail-oriented Claims Processor to ensure accurate and timely processing of healthcare claims. The role is full-time, 40 hours/week, Monday–Friday, 8am–5pm, on-site at 17 Technology Cir, Columbia, SC 29203.

Candidates must be a U.S. citizen and able to obtain a security clearance. Benefits include substantial health plans, 401k with company match, PTO, and more, as part of a comprehensive package.

Qualifications

• High School Diploma or equivalent.
• 1 year of healthcare or insurance experience preferred.
• Strong analytical, organizational, and customer service abilities.
• Proficient spelling, punctuation, and grammar.
• Ability to obtain security clearance.

Responsibilities

• Research and process claims according to regulations and guidelines.
• Verifies the coding of procedure and diagnosis codes.
• Resolves system edits, audits, and claim errors through research and approved references.
• Coordinates with internal departments to work edits and deferrals and update patient and provider information.

Skills

Analytical skills

Organizational skills

Customer service

Oral and written communication

Spelling & grammar

Judgment

Basic math

Education

High School Diploma or equivalent

Tools

Word processing

Spreadsheet

Database basics

Job description

Summary

Responsible for the accurate and timely processing of claims.

Description

Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies

Location: This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. This role is located on-site at 17 Technology Cir, Columbia, SC 29203.

Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

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). To comply with the McNamara-O'Hara Service Contract Act (SCA), employees must enroll in our health insurance even if they have other health insurance. Employees will receive supplemental pay for health insurance until they are enrolled in our health insurance, first of the month following 28 days after the hire date.

What You’ll Do

• Research and processes claim 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.

Required Education

High School Diploma or equivalent

Required Skills and Abilities

• 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.

Preferred Work Experience

1 year-of experience in a healthcare or insurance environment.

Preferred Skills and Abilities

• 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

• 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

Sponsorship

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

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.

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

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 impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision.

We are an Equal Opportunity Employer.

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Company Information

PGBA, LLC is a leading provider of administrative services for the TRICARE health benefit program and health benefit programs of Veteran’s Health Administration for both state and federal governments. The company has offices in Florence, Surfside Beach, and Columbia, South Carolina. PGBA employees work in an atmosphere that is conducive to growth and on that fosters a focus on personal and professional development with an environment made up of people from different parts of the world with diverse cultural Excellent benefits, as well as a competitive compensation program, make us one of the leading employers in today’s corporate market.