Claims Processor II

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health benefits

401k with company match

Life Insurance

Paid Time Off

On-site facilities (cafeteria & gym)

Job summary

BlueCross BlueShield of South Carolina is hiring for a full-time claims reviewer/adjudicator based in Columbia, SC. You will review and process complex claims, determine eligibility for payment, and assist in training new staff within a structured environment.

The role requires strong organizational, analytical, and communication skills, with attention to accuracy in coding, data entry, and compliance. The position supports standard office hours and offers a collaborative team culture.

Qualifications

• Education: High School Diploma or equivalent.
• Work Experience: 2 years of experience processing, researching and adjudicating claims.
• Skills & Abilities: strong organizational, analytical and judgment skills; strong oral and written communication; proficient in spelling, punctuation and grammar; proficient in basic business math; ability to handle confidential or sensitive information with discretion.
• Software & Tools: Microsoft Office.

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.
• 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.

Skills

Organizational skills

Analytical skills

Judgment skills

Oral communication

Written communication

Spelling and grammar

Business math

Discretion with confidential info

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary

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.

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.

Location

This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. This role is located at 17 Technology Cir, Columbia, SC, 29203.

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.
• 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

• 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