Claims Processor I - Part-Time

BlueCross and BlueShield of South Carolina; Myrtle Beach (SC); On-site; USD 23,000 - 34,000; Part time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401K with company match

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Wellness program

Tuition assistance

Employee recognition

Employee discounts

Employee Assistance

Job summary

BlueCross BlueShield of South Carolina is seeking a Claims Processor for 20 hours per week, on-site in Myrtle Beach. You will review and adjudicate complex or specialty claims following contract regulations and internal guidelines. You will enter claims into our system, verify coding accuracy, and ensure processing meets quality and production standards.

Occasional overtime and travel between buildings may be required. Applicants must be a U.S.

Qualifications

• Strong organizational, analytical and judgment skills.
• Excellent written and verbal communication abilities.
• Ability to maintain confidentiality and handle sensitive information.

Responsibilities

• 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; uses policies, forms and coordinates with internal support areas; responds to routine correspondence and completes spreadsheets.

Skills

Organizational skills

Analytical skills

Judgment skills

Oral & written communication

Confidential info handling

Basic business math

Discretion

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

Responsible for the accurate and timely processing of claims.

Description

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. 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 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 the 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.