Claims Processor I - Detail-Driven Claims Specialist

Pgba, Llc; Columbia (SC); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health plans

401k retirement

Life Insurance

Paid Time Off

On-site cafeterias

Education assistance

Service recognition

Employee discounts

Job summary

BlueCross BlueShield of South Carolina is hiring for an on-site Claims Processor in Columbia. The role focuses on accurate, timely processing of claims in a 40-hour week, with security clearance requirements and service-contract act considerations.

Responsibilities include researching and processing claims, verifying procedure and diagnosis codes, resolving edits, and coordinating with internal departments to update patient and provider information.

Qualifications

• High School Diploma or equivalent.
• 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.

Responsibilities

• 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.

Skills

Analytical

Organizational

Customer Service

Communication

Spelling & Grammar

Judgment

Basic Math

Education

HS Diploma

Tools

Word Processing

Spreadsheet Apps

Database Software

Job description

BlueCross BlueShield of South Carolina is hiring for an on-site Claims Processor in Columbia. The role focuses on accurate, timely processing of claims in a 40-hour week, with security clearance requirements and service-contract act considerations.

Responsibilities include researching and processing claims, verifying procedure and diagnosis codes, resolving edits, and coordinating with internal departments to update patient and provider information.