Specialist, Provider File I-2

001 BlueCross and BlueShield of South Carolina; Florence (SC); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k retirement savings plan with firm

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 an administrative professional to verify and certify healthcare providers, maintain provider data, and support network enrollment processes. The role requires strong Microsoft Office skills and the ability to handle confidential information with discretion.

You will work with provider management systems, assist with special projects, and contribute to timely claims adjudication and provider billing support.

Qualifications

• High School Diploma or equivalent required.
• 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Working knowledge of word processing and spreadsheet software; ability to learn PIMS is a plus.
• Proficient in Microsoft Office; strong written and verbal communication; good organizational skills.

Responsibilities

• Verify information and establish certification of healthcare service providers.
• Prepare and maintain provider data in the provider information management system (PIMS).
• Assign providers to the appropriate network and provider system/database.
• Support department production standards via PIMS and AMMS maintenance and reports.
• Participate in special projects, such as mass rate updates or quality improvement audits.

Skills

Word processing

Spreadsheet

Customer service

Verbal/written communication

Basic business math

Confidential information handling

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

Summary Responsible for establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Sponsorship: This position is not eligible for sponsorship now or in the future.

Description Logistics

BlueCross BlueShield of South Carolina - About Us | BlueCross BlueShield of South Carolina Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings.

This role is located onsite at 200 North Dozier Boulevard Florence, SC 29501.

SCA Benefit Requirements

BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

What You’ll Do

• Verifies necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or establishes certification of healthcare service providers.
• Prepares provider files/maintains provider data (updates, additions, deletions) on the provider information management system (PIMS) or appropriate provider system/database.
• Identifies/assigns providers to the appropriate network and provider system/database.
• Contributes to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.
• Contributes to and participates on special projects, which may include but are not limited to the following: mass rate updates, quality improvement, audits, etc..

To Qualify for This Position, You’ll Need the Following

• Required Education: High School Diploma or equivalent
• Required Work Experience: 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Required Skills and Abilities: Working knowledge of word processing and spreadsheet software. Knowledge/understanding of or ability to acquire PIMS. Good judgment skills. Effective customer service and organizational skills. Demonstrated verbal and written communication skills. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion.
• Required Software and Tools: Microsoft Office.

Work Environment

Typical office environment. May involve travel between office buildings.

We Prefer That You Have the Following

• Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes.
• Excellent telephone skills and previous Customer Service experience.

Our Comprehensive Benefits Package Includes The Following

• Subsidized health plans
• Dental and vision coverage
• 401k retirement savings plan with company match
• Life Insurance
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status.

Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans.

It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email [e-mail] or call 800-288-2227, ext. 47480 with the nature of your request.

We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision.

We are an Equal Opportunity Employer.

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Some states have required notifications.

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Welcome Here’s Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full‑time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty.