Claims Processor II

Pgba, Llc; Columbia, Northern (SC, KY); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

On-site cafeterias and fitness centers

Education Assistance

Paid Time Off (PTO)

Job summary

PGBA, a BlueCross BlueShield South Carolina subsidiary, is seeking a Claims Processor II to join our Columbia, SC office. This full-time, on-site role runs Monday–Friday, 8am–5pm, at 17 Technology Circle, Columbia, SC 29203. Sponsorship is not available for this position.

The ideal candidate will review and adjudicate complex claims, verify coding accuracy, and ensure compliance with internal standards while mentoring newer staff. Strong organizational and communication skills are essential.

Qualifications

• High School Diploma or equivalent.
• 2 years of experience processing, researching and adjudicating claims.
• Strong organizational, analytical and judgment skills.
• Proficient in spelling, punctuation and grammar; basic business math.

Responsibilities

• Examines and processes complex or specialty claims according to regulations and guidelines.
• Enters claims into the claim system after verification of coding.
• Verifies correct keying of procedures and diagnosis codes.
• Ensures processing according to established quality and production standards; corrects errors.
• Resolves claim edits and deferrals; researches problems using policies and forms; coordinates with internal support areas.
• Responds to routine correspondence and completes spreadsheets as applicable.

Skills

Organizational skills

Analytical skills

Judgment skills

Oral and written communication

Confidentiality

Business math

Education

High School Diploma or equivalent

Tools

Microsoft Office

Database software

Job description

## Claims Processor IIApply: On-site: Columbia, South Carolina: Full time: Posted 2 Days Ago: End Date: September 28, 2026 (1 day left to apply): R1051986# **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****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 (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. The role is located on-site at 17 Technology Circle, 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. 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 for 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* 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.**What To Expect Next:**After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.**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.