Claims Processor I

Southcarolinablues; Myrtle Beach (SC); On-site; USD 36,000 - 52,000; Full time

Benefits offered by this job

Health plans

401k with company match

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Job summary

BlueCross BlueShield of South Carolina in Myrtle Beach seeks a Claims Processor who will ensure accurate and timely processing of claims in a high-volume environment. The on-site role requires US citizenship for security clearance, a high school diploma or equivalent, and strong analytical, mathematical and communication skills to verify codes and resolve edits across departments.

Join a large SC employer with comprehensive benefits including health plans, 401k matching, life insurance, PTO,

Qualifications

• High school diploma or equivalent required.
• Strong analytical, organizational and customer service skills.
• Strong oral and written communication skills.
• Excellent spelling, punctuation and grammar.
• Good judgment and basic business math.
• Experience with word processing and spreadsheets is preferred.
• Experience in healthcare or insurance environment preferred.

Responsibilities

• Researches and processes claims according to regulations and guidelines.
• Verifies coding of procedure and diagnosis codes.
• Resolves system edits and errors through research and references.
• Coordinates with internal departments on edits and deferrals.

Skills

Analytical skills

Communication skills

Oral communication

Written communication

Judgment skills

Basic math

Word processing

Spreadsheets

Education

High School Diploma or equivalent

Tools

Database software

Job description

Summary

Responsible for the accurate and timely processing of claims.

Why join us

BlueCross BlueShield of South Carolina has been a 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 in a typical office environment. This role is located on‑site at 8733 Highway 17 Bypass, Myrtle Beach, SC, 29575.

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

• 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
• Required Skills and Abilities: Strong analytical, organizational and customer service skills.
• Required Skills and Abilities: Strong oral and written communication skills.
• Required Skills and Abilities: Proficient spelling, punctuation and grammar skills.
• Required Skills and Abilities: Good judgment skills.
• Required Skills and Abilities: 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.
• Preferred Software and Other Tools: 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

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 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.

Veterans Welcome

BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full‑time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.