Part-Time Claims Specialist | On-Site in Myrtle Beach

Pgba, Llc; Myrtle Beach (SC); On-site; USD 25,000 - 36,000; Part time

Job summary

PGBA, a BlueCross BlueShield of South Carolina subsidiary, is seeking a part-time Claims Processor I for on-site work in Myrtle Beach. The role involves reviewing and adjudicating complex or specialty claims, entering claims with accurate coding, and ensuring adherence to quality standards.

You will verify procedures and diagnosis codes, resolve edits, and assist in training newer staff. Requires a high school diploma and 2 years of related experience.

Qualifications

• High School Diploma or equivalent required.
• 2 years of experience processing, researching, and adjudicating claims.
• Strong organizational, analytical and judgment skills with solid written and oral communication.

Responsibilities

• Review and adjudicate complex or specialty claims in accordance with regulations and standards.
• Enter claims into the system and verify correct coding of procedures and diagnoses.
• Monitor quality and production standards, correcting processing errors as needed.
• Research and resolve claims edits and deferrals using internal resources.

Skills

Organizational skills

Analytical skills

Judgment

Oral communication

Written communication

Confidentiality

Business math

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

PGBA, a BlueCross BlueShield of South Carolina subsidiary, is seeking a part-time Claims Processor I for on-site work in Myrtle Beach. The role involves reviewing and adjudicating complex or specialty claims, entering claims with accurate coding, and ensuring adherence to quality standards.

You will verify procedures and diagnosis codes, resolve edits, and assist in training newer staff. Requires a high school diploma and 2 years of related experience.