Senior Claims Adjudication Specialist

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Health benefits

401k with company match

Life Insurance

Paid Time Off

On-site facilities (cafeteria & gym)

Job summary

BlueCross BlueShield of South Carolina is hiring for a full-time claims reviewer/adjudicator based in Columbia, SC. You will review and process complex claims, determine eligibility for payment, and assist in training new staff within a structured environment.

The role requires strong organizational, analytical, and communication skills, with attention to accuracy in coding, data entry, and compliance. The position supports standard office hours and offers a collaborative team culture.

Qualifications

• Education: High School Diploma or equivalent.
• Work Experience: 2 years of experience processing, researching and adjudicating claims.
• Skills & Abilities: strong organizational, analytical and judgment skills; strong oral and written communication; proficient in spelling, punctuation and grammar; proficient in basic business math; ability to handle confidential or sensitive information with discretion.
• Software & Tools: Microsoft Office.

Responsibilities

• Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Verifies that claims have been keyed correctly.
• Ensures that claims are processing according to established quality and production standards.
• Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
• Researches and resolves claims edits and deferrals.
• Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
• Responds to routine correspondence and completes spreadsheet if applicable.

Skills

Organizational skills

Analytical skills

Judgment skills

Oral communication

Written communication

Spelling and grammar

Business math

Discretion with confidential info

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is hiring for a full-time claims reviewer/adjudicator based in Columbia, SC. You will review and process complex claims, determine eligibility for payment, and assist in training new staff within a structured environment.

The role requires strong organizational, analytical, and communication skills, with attention to accuracy in coding, data entry, and compliance. The position supports standard office hours and offers a collaborative team culture.