Senior Complex Claims Adjudication Specialist

ourhrconnect; Columbia (SC); On-site; USD 42,000 - 62,000; Full time

Benefits offered by this job

Subsidized health plans, dental and视觉?

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 full-time Claims Adjudicator in Columbia, SC. The role requires evaluating complex or specialty claims, determining approval or denial, and paying claims per policy guidelines.

Responsibilities include processing claims, verifying codes, maintaining quality standards, and assisting in training new staff. Requires strong organizational and communication skills, and a 2-year claims background.

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.
• Proficient in spelling, punctuation and grammar.
• Proficient in basic business math.
• Ability to handle confidential or sensitive information with discretion.
• Proficient in Microsoft Office.

Responsibilities

• Examines and processes complex or specialty claims according to regulations and guidelines.
• Enters claims into the system after verification of correct coding.
• Ensures claims processing meets quality and production standards; corrects errors.
• Resolves claim issues by researching policies and coordinating with internal teams.

Skills

Organizational skills

Analytical skills

Judgment skills

Oral & written communication

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a full-time Claims Adjudicator in Columbia, SC. The role requires evaluating complex or specialty claims, determining approval or denial, and paying claims per policy guidelines.

Responsibilities include processing claims, verifying codes, maintaining quality standards, and assisting in training new staff. Requires strong organizational and communication skills, and a 2-year claims background.