Claims Processor I

Pgba, Llc; Myrtle Beach (SC); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan with公司匹配

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

PGBA, LLC is seeking a dedicated Claims Processor to ensure accurate and timely processing of claims in a full-time, on-site role at Myrtle Beach, SC. The position requires US citizenship for security clearance and offers comprehensive benefits.

You will verify codes, resolve edits, and coordinate with internal departments to update patient and provider information while adhering to regulatory standards and company policies.

Qualifications

• High School Diploma or equivalent required.
• Strong analytical, organizational and customer service skills.
• Excellent written and verbal communication; ability to use precise spelling and grammar.
• Good judgment and basic business math skills.

Responsibilities

• Researches and processes claims according to regulation, standards and guidelines.
• Verifies coding of procedures and diagnoses.
• Resolves system edits and errors through investigation and references.
• Coordinates with internal departments to update patient and provider information.

Skills

Analytical skills

Organizational skills

Customer service

Communication skills

Spelling & grammar

Judgment

Math basics

Education

High School diploma

Tools

Office equipment

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 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

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

• 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.

PGBA, LLC

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.