Processor, Claims II

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 40,000 - 56,000; Full time

Benefits offered by this job

Subsidized health plans

401k retirement savings plan with公司匹配

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a Summary Reviews and Adjudication professional to process complex or specialty claims. The role includes determining whether to return, deny, or pay claims in line with policies and procedures, with mentoring responsibilities for new staff.

Location is Columbia, SC, full-time, weekdays, office setting. Security clearance, US citizenship, and Service Contract Act considerations apply.

Qualifications

• Requires High School Diploma or equivalent.
• Two years of experience processing, researching and adjudicating claims.
• Proficient in Microsoft Office and basic math; strong communication and discretion.

Responsibilities

• Examines and processes complex or specialty claims according to regulations and standards.
• Enters claims into the claim system after verification of coding and diagnosis.
• Verifies that claims have been keyed correctly.
• Ensures processing according to quality and production standards.
• Corrects processing errors by reprocessing, adjusting or recouping claims.
• Researches and resolves claims edits and deferrals.
• Responds to routine correspondence and completes relevant spreadsheets.

Skills

Strong organizational skills

Analytical skills

Judgment skills

Oral communication

Written communication

Spelling/punctuation/grammar

Basic math

Discretion with confidential info

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.

Why should you join the BlueCross BlueShield of South Carolina family of companies?

Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.

Logistics:

PGBA– one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. This role is located at 17 Technology Cir, Columbia, SC, 29203.

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). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

Sponsorship:

This position is not eligible for sponsorship now or in the future.

What You’ll Do:

• 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.

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

Required Education:

High School Diploma or equivalent

Required Work Experience:

2 years of experience processing, researching and adjudicating claims.

Required Skills and Abilities:

• 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.

Required Software and Tools:

Microsoft Office.

We Prefer That You Have the Following:

Preferred Work Experience:

2 years of claims processing experience.

Preferred Skills and Abilities:

• Strong time management skills.
• Knowledge of mathematical and statistical concepts.

Preferred Software and Other Tools:

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

Our Comprehensive Benefits Package Includes the Following:

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.