Processor, Claims I

Pgba, Llc; Myrtle Beach (SC); Hybrid; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health insurance

Dental coverage

Vision coverage

401(k) with company match

Life Insurance

Paid Time Off

On-site facilities

Education assistance

Service recognition

National discounts

Job summary

PGBA, LLC is seeking a claims processing professional in Myrtle Beach, SC to research and process healthcare claims in line with regulations and internal guidelines.

The role requires strong analytical and communication skills, plus attention to detail and basic math. On-site work, with benefits including health plans, 401(k) and PTO.

Qualifications

• High School Diploma or equivalent required.
• Strong analytical, organizational and customer service skills.
• Good written and oral communication, spelling/grammar, and judgment.

Responsibilities

• Researches and processes claims according to regulations and internal standards.
• Verifies coding of procedure and diagnosis codes.
• Resolves system edits, audits and claims errors with approved references.
• Coordinates with internal departments to handle edits/deferrals and updates to patient and provider data.

Skills

Analytical skills

Organizational skills

Customer service

Written communication

Oral communication

Spelling/Punctuation/Grammar

Good judgment

Basic math

Education

High School Diploma or equivalent

Tools

Basic office equipment

Word processing

Spreadsheet software

Database software

Job description

### To learn more about our website privacy policy, click on this .* **Government Clearance**: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.* **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.*** 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.* **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 Work Experience:**1 year-of experience in a healthcare or insurance environment.* **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.* 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 moreIf 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.PGBA, LLC is a leading provider of administrative services for the TRICARE health benefit program and health benefit programs of Veteran's Health Administration for both state and federal governments. The company has offices in Florence, Surfside Beach, and Columbia, South Carolina.PGBA employees work in an atmosphere that is conducive to growth and on that fosters a focus on personal and professional development with an environment made up of people from different parts of the world with diverse cultural Excellent benefits, as well as a competitive compensation program, make us one of the leading employers in today's corporate market.