Senior Complex Claims Adjudicator

Blue Cross Blue Shiel; Nashville (TN); On-site; USD 40,000 - 60,000; Full time

Benefits offered by this job

401k retirement savings plan with team

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Education Assistance

Job summary

BlueCross BlueShield of South Carolina in Nashville, TN is seeking a claims adjudicator to review and process complex or specialty claims, determining whether to return, deny or pay according to policy.

You will enter claims, verify correct coding, and ensure accuracy against quality and production standards while supporting training of new staff. This role offers a stable environment with benefits and opportunities for growth.

Qualifications

• High School Diploma or equivalent required.
• At least 2 years of experience processing, researching and adjudicating claims.
• Strong organizational and communication skills; attention to detail.
• Proficient in basic business math and grammar.

Responsibilities

• Review and adjudicate complex or specialty claims per policies.
• Enter claims in the system with correct coding.
• Ensure processing accuracy and quality standards.
• Research claim issues using policies and coordinate with internal teams.
• Respond to routine correspondence and maintain records.

Skills

Analytical skills

Organizational skills

Communication skills

Microsoft Office proficiency

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina in Nashville, TN is seeking a claims adjudicator to review and process complex or specialty claims, determining whether to return, deny or pay according to policy.

You will enter claims, verify correct coding, and ensure accuracy against quality and production standards while supporting training of new staff. This role offers a stable environment with benefits and opportunities for growth.