Provider Enrollment Leader – Healthcare Operations

033 Palmetto GBA; Columbia (SC); On-site; USD 85,000 - 110,000; Full time

Job summary

BlueCross BlueShield of South Carolina is seeking a leader to manage the provider enrollment unit at our Columbia, SC office. This full-time role oversees enrollment staff, ensures timely provider enrollment, and maintains compliance with regulatory requirements.

You will drive performance, supervise analysts, identify fraud risks, and partner across departments to improve processes. A Bachelor's degree and several years in healthcare operations, with leadership experience, are required, and

Qualifications

• Bachelor's degree in a job-related field is required.
• 5 years of healthcare, Medicare, health insurance operations, or operations experience.
• 2 years of leadership experience (may be concurrent with the 5 years).
• Excellent verbal and written communication, organizational and customer service skills.
• Excellent presentation, analytical or critical thinking skills.
• Excellent problem-solving skills and good judgment.
• Spelling, grammar, and punctuation proficiency.
• Ability to persuade, negotiate or influence others.
• Ability to handle confidential or sensitive information with discretion.
• Ability to listen effectively and respond quickly.
• Proficiency in Microsoft Office.

Responsibilities

• Oversee enrollment staff to ensure accurate, timely provider enrollment and claims processing.
• Manage performance to meet productivity, quality, and timeliness standards.
• Ensure compliance with applicable laws and regulations and stay updated on new requirements.
• Direct fraud identification and investigations with the analyst staff.
• Collaborate with management to define goals, objectives and performance measures.
• Develop and maintain quality assurance activities.
• Analyze reports and trends to identify improvement opportunities.
• Coordinate with internal departments to implement process and system improvements.
• Prepare and verify reports as necessary.

Skills

Verbal and written communication

Organizational skills

Customer service

Analytical thinking

Problem solving

Discretion with confidential info

Spelling grammar punctuation

Persuasion negotiation

Education

Bachelor's degree in a job-related field

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a leader to manage the provider enrollment unit at our Columbia, SC office. This full-time role oversees enrollment staff, ensures timely provider enrollment, and maintains compliance with regulatory requirements.

You will drive performance, supervise analysts, identify fraud risks, and partner across departments to improve processes. A Bachelor's degree and several years in healthcare operations, with leadership experience, are required, and