Summary
 

Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes.

Description
 

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!

Position Purpose: Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes.

Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies. 

Location: This position is full-time (40 hours/week), Monday-Friday, from 8:00 AM to 5:00 PM, and will be onsite at one of the following locations: 2743 Perimeter Pkwy, Augusta, GA 30909; 200 N Dozier Blvd, Florence, SC 29501; or 17 Technology Cir, Columbia, SC 29203.

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

What You’ll Do:

• Processes denials of claims. Processes adjustment claims for both pre-pay and post-pay departments.

• Investigates and analyzes adjustment claim history and denial records.

• Prescreens records for review and maintains accurate records of all claims.

• Communicates with provider community and assists provider service department in responding to inquiries. Generates educational correspondence to providers regarding denials.

• Performs quality control of work processes.

• Assists manager with special projects.

To Qualify for This Position, You'll Need the Following:

• Required Education: Associate's

• Degree Equivalency: 2 years job related work experience

• Required Work Experience: 1 year administrative/clerical support.

• Required Skills and Abilities:

• Working knowledge of word processing software.

• Strong analytical, organizational, and customer service skills.

• Strong verbal and written communication skills.

• Proficiency in spelling, punctuation, and grammar skills.

• Good judgment skills.

• Ability to handle confidential or sensitive information with discretion.

• Required Software and Tools: Microsoft Office.

We Prefer That You Have the Following:

• Preferred Software and Other Tools:

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits for the first of the month following 28 days of employment.  

• 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.

What To Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

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 [email protected] 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. Here's more information.

Some states have required notifications. Here's more information.