Claims Processor I

Pgba, Llc; Florence (SC); Hybrid; USD 15,000 - 21,000; Part time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

PGBA, LLC, a leading administrator for TRICARE and SC health programs, is seeking a part-time Claims Processor I in Florence, SC. The role emphasizes accurate and timely processing of insurance claims in a busy office environment.

Responsibilities include researching and processing claims, verifying coding accuracy, resolving system edits, and coordinating with internal departments to correct records and deferrals. Training will run five weeks, 8am-4:30pm, Monday to Friday.

Qualifications

• High School diploma or equivalent is required.
• Strong analytical, organizational and customer service skills are required.
• Excellent oral and written communication and grammar are essential.
• Good judgment and basic business math skills are required.

Responsibilities

• Researches and processes claims according to regulations, standards and processing guidelines; verifies coding of procedures and diagnoses.
• Resolves system edits, audits and claims errors through research and approved references.
• Coordinates with internal departments to work edits/deferrals and updates patient and insurer records as necessary.

Skills

Strong analytical

Organizational skills

Customer service skills

Oral and written communication

Spelling punctuation and grammar

Good judgment

Basic math

Education

High School Diploma or equivalent

Tools

Word processing

Spreadsheets

Database software

Basic office equipment

Job description

### To learn more about our website privacy policy, click on this .# **Summary**We are currently hiring for a Claims Processor I to join BlueCross BlueShield of South Carolina. You will be responsible for the accurate and timely processing of claims.Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.# **Description****Position Purpose:** Responsible for the accurate and timely processing of claims.**Logistics:** **- one of BlueCross BlueShield's South Carolina subsidiary companies.****Location:** This position is part-time (20-hours/week) Monday-Friday from 8am-12pm and training will be Monday-Friday from 8am-4:30pm for five weeks in a typical office environment. This role is located on-site at 200 North Dozier Boulevard, Florence, SC 29501.**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.* Resolve system edits, audits and claims errors through research and use of approved references and investigative sources.* Coordinate 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* **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.**We Prefer That You Have the Following:*** **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:**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.**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. Here'sSome states have required notifications. Here's .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.