Provider File Specialist I — On-Site

Southcarolinablues; Columbia, Northern (SC, KY); Hybrid; USD 42,000 - 56,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off

On-site cafeterias & fitness centers

Job summary

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.

Qualifications

• 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.

Responsibilities

• 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.

Skills

Administrative support

Clerical work

Customer service

Claims processing

Provider network

Education

High School Diploma

Tools

Microsoft Office

Job description

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.