Claims Specialist: Complex & Specialty Claims

CGS Administrators LLC; Nashville (TN); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health benefits

401k with match

Life Insurance

PTO

Wellness amenities

Education assistance

Service recognition

Discount programs

Job summary

BlueCross BlueShield of South Carolina is seeking an experienced claims examiner to review and adjudicate complex or specialty claims. You will verify coding, enter claims, and ensure accurate processing in our claims system. Training will be provided; strong analytical and communication skills are essential.

The role is full-time in Nashville, TN, with typical 8-hour daytime shifts. We value accuracy, discretion with sensitive information, and commitment to quality service for our members and

Qualifications

• High School Diploma or equivalent.
• 2 years of experience processing, researching and adjudicating claims.
• 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.
• 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 and written communication

Microsoft Office

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking an experienced claims examiner to review and adjudicate complex or specialty claims. You will verify coding, enter claims, and ensure accurate processing in our claims system. Training will be provided; strong analytical and communication skills are essential.

The role is full-time in Nashville, TN, with typical 8-hour daytime shifts. We value accuracy, discretion with sensitive information, and commitment to quality service for our members and