Claims Processor I: Detail-Driven Claims Specialist

Pgba, Llc; Columbia, Northern (SC, KY); Hybrid; USD 40,000 - 55,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off

On-site cafeterias & fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

PGBA, a BlueCross BlueShield subsidiary, is seeking a Claims Processor I to join our Columbia, SC office. This full-time role runs Monday–Friday, 8am–5pm, on-site at 17 Technology Cir, Columbia, SC 29203, requiring U.S. citizenship for security clearance.

You will research and process claims, verify procedure/diagnosis codes, and resolve system edits and errors per guidelines. Training and benefits are provided on schedule.

Qualifications

• 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

• Research and processes claim 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 patient identification and related files.

Skills

Analytical skills

Organizational skills

Customer service

Communication skills

Spelling & grammar

Judgment

Basic math

Education

High School Diploma or equivalent

Tools

Word processing

Spreadsheets

Database software

Job description

PGBA, a BlueCross BlueShield subsidiary, is seeking a Claims Processor I to join our Columbia, SC office. This full-time role runs Monday–Friday, 8am–5pm, on-site at 17 Technology Cir, Columbia, SC 29203, requiring U.S. citizenship for security clearance.

You will research and process claims, verify procedure/diagnosis codes, and resolve system edits and errors per guidelines. Training and benefits are provided on schedule.