Processor, Claims I

Palmetto GBA, LLC; Columbia (SC); Hybrid; USD 36,000 - 54,000; Full time

Benefits offered by this job

Health plans including dental and life

401k retirement plan with company fit

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education assistance

Service recognition

National discounts

Job summary

Palmetto GBA, LLC, a BlueCross BlueShield South Carolina subsidiary, is seeking an on-site Claims Processing Specialist in Columbia for a full-time role (40 hours/week, Monday–Friday, 8:00am–5:00pm).

The position focuses on accurate and timely processing of medical claims, verification of coding, and resolving system edits while coordinating with internal teams. Eligible benefits include health plans, 401k, PTO, and education assistance.

Qualifications

• High School Diploma or equivalent required.
• Strong analytical, organizational and customer service skills.
• Proficient spelling, punctuation and grammar.
• Strong oral and written communication abilities.

Responsibilities

• Researches and processes claims according to regulations and guidelines.
• Verifies coding of procedure and diagnosis codes.
• Resolves system edits and claims errors through research and references.
• Coordinates with internal departments to update patient and provider files.

Skills

Analytical skills

Organizational skills

Customer service

Written communication

Basic math

Education

High School Diploma or equivalent

Tools

Basic office software

Job description

Responsible for the accurate and timely processing of claims. Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am-5:00pm in a typical office environment.

This role is located on-site at 17 Technology Cir, Columbia, SC 29203.

SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). To comply with the McNamara-O'Hara Service Contract Act (SCA), employees must enroll in our health insurance even if they have other health insurance. Employees will receive supplemental pay for health insurance until they are enrolled in our health insurance, first of the month following 28 days after the hire date.

What You'll Do

Researches and processes claims according to business regulation, internal standards and processing guidelines.

Verifies the coding of procedure and diagnosis codes.

Resolves system edits, audits and claims errors through research and use of approved references and investigative sources.

Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.

To Qualify for This Position, You'll Need the Following

Required Education:

• High School Diploma or equivalent

Required Skills and Abilities:

• Strong analytical, organizational and customer service skills.
• Strong oral and written communication skills.
• Proficient spelling, punctuation and grammar skills.
• Good judgment skills.
• Basic business math skills

Required Software and Tools:

• Basic office equipment.

Preferred Skills and Abilities:

• Ability to use complex mathematical calculations.

Preferred Software and Other Tools:

• Proficient in word processing and spreadsheet applications.
• Proficient in database software.

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.

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.

Palmetto GBA is a healthcare service administrator and one of the nation's largest providers of high-volume medical claims and transaction processing. We provide services and technology solutions to improve and streamline healthcare administration not only for government but also for corporate entities. We offer a wide range of services that require a diverse workforce and expansive areas of expertise from data analytics, administrative and workflow services to advanced systems. To help our associates succeed and reach their professional goal, we offer training classes and programs that help employees prepare for leadership positions and offer tuition assistance for education advancement. Palmetto GBA acknowledges associates’ hard work and dedication with awards and financial incentives.