Claims Processor I - Part-Time

001 BlueCross and BlueShield of South Carolina; Myrtle Beach (SC); On-site; USD 22,000 - 30,000; Part time

Benefits offered by this job

Health insurance

401K retirement savings

Paid Time Off

On-site fitness centers

Tuition assistance

Job summary

BlueCross BlueShield of South Carolina is seeking a dedicated claims processor to accurately and promptly process complex or specialty claims in a full-time environment. The role requires attention to coding accuracy, adherence to policies, and collaboration with internal support teams.

Responsibilities include entering and verifying claims, correcting processing errors, and responding to routine correspondence. Training will occur onsite, with potential overtime as needed.

Qualifications

• Two years of experience processing, researching, and adjudicating claims.
• High School Diploma or equivalent required.
• Strong proficiency with Microsoft Office and data entry.

Responsibilities

• Examines and processes complex or specialty claims.
• Enters claims into the claim system after verification of correct coding.
• Verifies that claims have been keyed correctly and processed per standards.
• Ensures claims are processed according to quality and production standards.
• Corrects processing errors by reprocessing, adjusting, or recouping claims.
• Researches and resolves claim edits and deferrals.
• Responds to routine correspondence and maintains spreadsheets.

Skills

Organizational skills

Analytical skills

Judgment skills

Oral communication

Written communication

Spelling & grammar

Basic math

Confidentiality

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

Responsible for the accurate and timely processing of claims.

Why 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 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

• Reviews and adjudicates complex or specialty claims.
• Determines whether to return, deny or pay claims following organizational policies and procedures.
• Assists in training or mentoring new staff members.

Logistics

PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies.

Location

This position is full-time (20 hours/week) Monday through Friday in a typical office environment. You will work a 4-hour sift scheduled during our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located on-site at 8733 Highway 17 Bypass, Myrtle Beach, SC.

Training

Training will be onsite Monday-Friday 8:00 AM -5 PM for approximately 8-10 weeks.

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

• Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Verifies that claims have been keyed correctly.
• Ensures that claims are processing according to established quality and production standards.
• Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
• Researches and resolves claims edits and deferrals.
• Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
• Responds to routine correspondence and completes spreadsheet if applicable.

To Qualify for This Position, You'll Need the Following:

Required Education

High School Diploma or equivalent

Required Work Experience

2 years of experience processing, researching, and adjudicating claims.

Required Skills and Abilities

• Strong organizational, analytical and judgment skills.
• Strong oral and written communication skills.
• Proficient in spelling, punctuation and grammar.
• Proficient in basic business math.
• Ability to handle confidential or sensitive information with discretion.

Required Software and Tools

Microsoft Office

We Prefer That You Have the Following:

Preferred Work Experience

• 2 years of claims processing experience.
• Tricare claims experience.

Preferred Skills and Abilities

• Strong time management skills.
• Knowledge of mathematical and statistical concepts.

Preferred Software and Other Tools

• Proficient in word processing and spreadsheet applications.
• proficient database software skills

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards. You will be eligible to participate in benefits the first of the month following 28 days of employment.

• 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
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Employee Assistance
• Discounts to movies, theaters, zoos, theme parks and more

What We can Do for You

We 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. Here's more information. Some states have required notifications. Here's more information.

Veterans Welcome

BlueCross 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. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. 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.

Welcome

Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!