Senior Claims Adjudicator – Complex & Specialty Claims

ourhrconnect; Nashville (TN); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Subsidized health plans

401k with company match

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Service Recognition

National discounts

Job summary

BlueCross BlueShield of South Carolina is seeking a claims adjudicator in Nashville to review complex or specialty claims and determine pay, denial, or return decisions. The role supports training and mentoring new staff within a full-time office environment.

The position requires strong organizational and analytical skills, plus proficiency in Microsoft Office. You will work with internal teams to ensure accurate coding and timely resolution of claims.

Qualifications

• Requires High School Diploma or equivalent.
• 2 years of experience processing, researching and adjudicating claims.
• Strong organizational, analytical and judgment skills; solid communication and math abilities.

Responsibilities

• Examines and processes complex or specialty claims according to regulations and guidelines.
• Enters claims into the system after verification of coding and accuracy.
• Resolves issues by researching policy and contacting internal teams as needed.

Skills

Organizational skills

Analytical skills

Judgment

Communication skills

Spelling/grammar

Basic business math

Discretion with sensitive info

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a claims adjudicator in Nashville to review complex or specialty claims and determine pay, denial, or return decisions. The role supports training and mentoring new staff within a full-time office environment.

The position requires strong organizational and analytical skills, plus proficiency in Microsoft Office. You will work with internal teams to ensure accurate coding and timely resolution of claims.