Claims Processor I (On-site)

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

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k retirement savings

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

Discount programs

Job summary

BlueCross BlueShield of South Carolina is seeking a Claims Processor for full-time on-site work at our Columbia, SC location. You will process and verify medical claims, ensure accurate coding, and resolve errors with cross-department collaboration.

The role requires a high school diploma or equivalent and strong analytical, organizational and communication skills. We offer comprehensive benefits and a stable, long-term career path within a federal contractor environment.

Qualifications

• Required Education: High School Diploma or equivalent.
• Required Skills and Abilities: Strong analytical, organizational and customer service skills; strong oral and written communication; good spelling, punctuation and grammar; good judgment; basic business math.
• Preferred Skills: Claims processing experience.
• Preferred Software/Tools: Proficient in word processing and spreadsheet apps; proficient in database software.

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 patient identification and other files as necessary.

Skills

Analytical skills

Organizational skills

Customer service

Oral and written communication

Spelling/grammar

Judgment

Business math

Education

High School diploma or equivalent

Tools

Basic office equipment

Job description

Summary Responsible for the accurate and timely processing of claims.

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.

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 17 Technology Cir, Columbia, SC 29203.

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). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

Sponsorship:

This position is not eligible for sponsorship now or in the future.

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.

Required Software and Tools:

Basic office equipment.

Preferred Skills and Abilities:

Ability to use complex mathematical calculations. Claims processing experience.

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 does 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.