Provider File Specialist II

Palmetto GBA, LLC; Columbia, Northern (SC, KY); Hybrid; USD 42,000 - 64,000; Full time

Benefits offered by this job

On-site cafeterias and fitness centers

Education Assistance

Paid Time Off (PTO)

Job summary

Palmetto GBA, LLC is seeking a Provider File Specialist II to maintain provider files and enrollment on provider systems. The role involves data updates, reporting, and supporting system enhancements in a full-time on-site position in Columbia, SC.

Responsibilities include processing provider information, generating management reports, and resolving provider issues related to eligibility and billing. Requires strong communication and confidentiality, with the possibility of occasional overtime

Qualifications

• High School Diploma or equivalent.
• 3 years of experience in customer service, claims processing, and/or provider network certification, or combination.
• Working knowledge of DB2 or other database software.
• Proficiency in word processing, spreadsheet, and database software; knowledge of PIMS and AMMS is a plus.

Responsibilities

• Obtains necessary information and establishes certification of healthcare service providers.
• Maintains provider data on the provider information management system (PIMS) or provider systems.
• Generates and analyzes provider reports for management.
• Provides system testing support for enhancements/modifications.
• Resolves issues from providers related to eligibility, recertifications, billing, etc.

Skills

Word processing

Spreadsheet

Database software

Verbal communication

Written communication

Analytical thinking

Discretion with confidential info

Education

High School Diploma

Tools

DB2

Job description

## Provider File Specialist IIApply: On-site: Columbia, South Carolina: Full time: Posted Yesterday: End Date: September 30, 2026 (18 days left to apply): R1052313# **Summary**Responsible for the maintenance of all provider files through assignment and enrollment on specified provider systems/databases. Responsible for running various queries for reporting on corporate, division, and department levels.# **Description****Logistics:** Palmetto GBA, **–** 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. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 17 Technology Circle, Columbia, SC, 29203.**Sponsorship**: This position is not eligible for sponsorship now or in the future.**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.**What You’ll Do:*** Obtains necessary information (written notifications, faxes, emails, or telephone contacts) and 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 systems/database.* Generates and analyzes various provider reports to management.* Assists with providing technical support through system testing to ensure system enhancements/modifications.* Researches/resolves issues/problems from providers related to eligibility, recertifications, edits, billing, etc.* 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.* **Required Experience:** 3 years of experience in customer service, claims processing, and/or provider network certification, or combination.* **Required Software and tools:** Microsoft Office. Working knowledge of DB2 or other database software.* **Required Skills and Abilities:** Working knowledge of word processing, spreadsheet, and database software. Knowledge/understanding of PIMS and AMMS. In-depth knowledge of provider certification process, claims processing operations/systems. In-depth knowledge of pricing methodology and discount programs. Good judgment skills. Demonstrated verbal and written communication skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Basic business math proficiency and knowledge of mathematical or statistical concepts. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.**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.