Claims Processor I-32

001 BlueCross and BlueShield of South Carolina; Florence (SC); On-site; USD 38,000 - 52,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

PTO

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

Discounts

Job summary

PGBA, LLC is seeking a detail-oriented Claims Processor to ensure accurate and timely processing of medical claims. This full-time, on-site role is based at 200 N Dozier Blvd, Florence, SC, with hours Monday–Friday, 8am–5pm.

Responsibilities include researching and processing claims, coding verification, and resolving system edits while coordinating with internal departments. A high school diploma is required; comprehensive benefits are provided.

Qualifications

• Researches and processes claims according to business regulations, standards and guidelines.
• Verifies coding of procedure and diagnosis codes.
• Resolves system edits, audits and claims errors through investigation and references.

Responsibilities

• Coordinates with internal departments to work edits and deferrals, updating patient and insurance data as needed.
• Provides accurate and timely claim processing to meet service level expectations.

Skills

Analytical skills

Organizational skills

Customer service

Education

High School Diploma or equivalent

Tools

Word processing

Spreadsheets

Database software

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 200 N Dozier Blvd, Florence, SC 29501.

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.
• Strong oral and written communication skills.
• Proficient spelling, punctuation and grammar skills.
• Good judgment skills.
• Basic business math skills

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 Description

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.

Veterans Welcome

Veterans Welcome! PGBA 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. 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.