Senior Claims Processor: Complex Claims Specialist

Southcarolinablues; Columbia (SC); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

Paid Time Off

Job summary

BlueCross BlueShield of South Carolina is seeking a Claims Processor II to review and adjudicate complex or specialty claims in Columbia, SC. The role includes entering claims with proper coding, verifying accuracy, and ensuring compliance with policies.

Ideal candidates will have 2 years of claims processing experience, strong organizational and communication skills, and proficiency in Microsoft Office. On-site work schedule is Monday–Friday, 40 hours per week.

Qualifications

• High School Diploma or equivalent required.
• 2 years of experience processing, researching and adjudicating claims.
• Strong organizational, analytical and judgment skills.
• Strong oral and written communication skills.

Responsibilities

• Review and adjudicate complex or specialty claims.
• Enter claims into the claim system with correct coding.
• Verify codes and ensure processing aligns with standards.
• Rectify processing errors by reprocessing, adjusting, or recouping claims.
• Research claim problems using policies and forms; coordinate with internal support areas.
• Respond to routine correspondence and maintain relevant spreadsheets.

Skills

Organizational skills

Analytical skills

Judgment/Decision making

Oral & written communication

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a Claims Processor II to review and adjudicate complex or specialty claims in Columbia, SC. The role includes entering claims with proper coding, verifying accuracy, and ensuring compliance with policies.

Ideal candidates will have 2 years of claims processing experience, strong organizational and communication skills, and proficiency in Microsoft Office. On-site work schedule is Monday–Friday, 40 hours per week.