Onsite Provider Data & Certification Specialist I

Southcarolinablues; Myrtle Beach, Northern (SC, KY); Hybrid; USD 36,000 - 48,000; Full time

Benefits offered by this job

On-site cafeterias

Fitness centers

401k with company match

Paid Time Off (PTO)

Health insurance

Education Assistance

Job summary

BlueCross BlueShield of South Carolina is hiring a Provider File Specialist I to maintain and certify healthcare provider files in the provider management systems. The role focuses on data integrity for provider directories and claims processes, with opportunities to support audits and quality initiatives.

The position is onsite in Myrtle Beach, requires 1 year of related experience, and offers standard business hours with potential travel between offices.

Qualifications

• High School Diploma or equivalent.
• 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Knowledge of word processing and spreadsheet software; ability to learn PIMS.
• Good judgment, effective customer service and organizational skills.
• Verbal and written communication skills; basic business math.
• Ability to handle confidential information with discretion.

Responsibilities

• Verifies information and/or establishes certification of healthcare service providers.
• Prepares and maintains provider files in the provider information management system (PIMS/AMMS).
• Identifies/assigns providers to the appropriate network/system.
• Contributes to department production standards and participates in special projects (QA, audits, etc.).
• May involve travel between office buildings.

Skills

Customer service

Data entry

Microsoft Office

Word processing

Spreadsheets

PIMS

Communication skills

Education

High School Diploma

Tools

PIMS

SQL

DB2

AMMS

Job description

BlueCross BlueShield of South Carolina is hiring a Provider File Specialist I to maintain and certify healthcare provider files in the provider management systems. The role focuses on data integrity for provider directories and claims processes, with opportunities to support audits and quality initiatives.

The position is onsite in Myrtle Beach, requires 1 year of related experience, and offers standard business hours with potential travel between offices.