Provider Data & Certification Specialist I

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 36,000 - 48,000; Full time

Benefits offered by this job

Health plans

401k

Life Insurance

Paid Time Off

On-site cafeterias

Education Assistance

Service Recognition

Job summary

BlueCross BlueShield of South Carolina is seeking an administrative professional to establish and maintain certification and provider files supporting provider directories and claims adjudication.

You will update provider data in PIMS, assign providers to networks, and support quality improvement projects. Strong MS Office skills and ability to handle sensitive information are required.

This full-time role is based in Columbia, SC, with typical hours 8-5, Monday through Friday.

Qualifications

• High School Diploma or equivalent required.
• 1 year of admin/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Proficient with Microsoft Office; ability to learn PIMS and other provider systems.

Responsibilities

• Verifies information to establish certification of healthcare providers.
• Maintains provider files and data on the provider information management system (PIMS).
• Identifies providers and assigns them to networks.
• Contributes to production standards by maintaining PIMS/AMMS data and generating reports.
• Participates in special projects such as mass rate updates, quality improvement, or audits.

Skills

Administrative support

Customer service

Data entry

Communication

Discretion

Education

High School Diploma or equivalent

Tools

PIMS

AMMS

Job description

BlueCross BlueShield of South Carolina is seeking an administrative professional to establish and maintain certification and provider files supporting provider directories and claims adjudication.

You will update provider data in PIMS, assign providers to networks, and support quality improvement projects. Strong MS Office skills and ability to handle sensitive information are required.

This full-time role is based in Columbia, SC, with typical hours 8-5, Monday through Friday.