Provider File Specialist I

Southcarolinablues; Columbia, Northern (SC, KY); Híbrido; USD 42.000 - 56.000; Jornada completa

Ventajas ofrecidas por este puesto de trabajo

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off

On-site cafeterias & fitness centers

Descripción de la vacante

BlueCross BlueShield of South Carolina is seeking a Provider File Specialist I to establish and maintain provider data for network providers and support accurate claims adjudication and provider billing. This on-site role requires updating provider records in PIMS and related systems.

You will verify provider information from notifications, faxes, emails, or calls, assign providers to networks, and support quality improvement projects.

Formación

• High School Diploma or equivalent required.
• Experience in administrative/clerical support, customer service, claims processing, or provider network/certification preferred.
• Proficiency with word processing and spreadsheets; basic business math.

Responsabilidades

• Verify information from written notifications, faxes, emails, or calls and establish provider certification.
• Maintain and update provider files in the provider information management system (PIMS) or related systems.
• Assign providers to appropriate networks and systems; support QA and audits.
• Assist with special projects such as mass rate updates and quality improvement initiatives.

Conocimientos

Administrative support

Clerical work

Customer service

Claims processing

Provider network

Educación

High School Diploma

Herramientas

Microsoft Office

Descripción del empleo

## Provider File Specialist IApply: On-site: Columbia, South Carolina: Full time: Posted Today: End Date: October 20, 2026 (12 days left to apply): R1052633# **Summary**Responsible for establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing. 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! Sponsorship: This position is not eligible for sponsorship now or in the future.# **Description****Logistics:** BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina**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 **8:00 AM-5:00 PM.** It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. **This role is located onsite at 17 Technology Circle Columbia, SC 29203.****What You’ll Do:*** Verifies necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or establishes certification of healthcare service providers. Prepares provider files/maintains provider data (updates, additions, deletions) on the provider information management system (PIMS) or appropriate provider system/database.* Identifies/assigns providers to the appropriate network and provider system/database.* Contributes to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.* Contributes to and participates on special projects, which may include but are not limited to the following: mass rate updates, quality improvement, audits, etc.**To Qualify for This Position, You’ll Need the Following:*** **Required Education:** High School Diploma or equivalent* **Degree Equivalency:*** **Required Experience:** 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.* **Required Software and Other Tools:** Microsoft Office* **Required Skills and Abilities:** Working knowledge of word processing and spreadsheet software. Knowledge/understanding of or ability to acquire PIMS. Good judgment skills. Effective customer service and organizational skills. Demonstrated verbal and written communication skills. Basic business math proficiency**.** Ability to handle confidential or sensitive information with discretion.**We Prefer That You Have the Following:*** **Preferred Skills and Abilities:** Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes.* Demonstrates strong telephone customer service skills.* Quality and auditing experience.**Our Comprehensive Benefits Package Includes The Following:**We offer our employees great benefits and rewards. You will be eligible to participate in the benefits 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.**What to Expect Next:**After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.**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. Here's more information.