Search the 72 jobs at BlueCross BlueShield of South Carolina

The SOX Auditor II role involves supporting the MAR/SOX Department with compliance tasks, including risk assessments, process documentation, testing of controls, and reporting deficiencies. Responsibilities also include generating reports, analyzing data, collaborating with management for accurate documentation, and identifying control inefficiencies.

The Quality Management Systems Auditor conducts ISO 9001 internal audits to ensure compliance across certified and prospective areas, collects and analyzes audit data, reports findings, and assists in maintaining the quality management system.

The Operations Analyst evaluates existing procedures, monitors performance metrics, and recommends operational improvements. They assist in implementing new systems, conduct audits, provide training, and maintain communication with management regarding project statuses, ensuring efficient departmental functions.

The Supervisor of Recovery oversees the Subrogation and Workers' Compensation department, ensuring quality control and adherence to laws and policies. The role involves handling personnel matters, maintaining public relations, advising staff on complex issues, and preparing corporate reports while monitoring production and performance standards.

As a Provider File Specialist I, you will establish and maintain healthcare provider files, support provider directories, ensure accurate claims adjudication, and assist with provider billing. Responsibilities include verifying information, preparing provider files, assigning providers to networks, and contributing to departmental projects and standards.

The Processor, Claims I will research and process claims according to guidelines, resolve claims errors, and coordinate with internal departments to manage claims effectively. They will also ensure the accuracy of coding for procedures and diagnoses.

As a Provider File Specialist I, you will manage and maintain healthcare provider files, ensuring accurate provider directories and claims processing. Responsibilities include verifying provider certifications, updating provider data in the management system, and contributing to departmental quality improvement projects.

Responsible for accurate and timely processing of claims by researching and verifying coding of procedure and diagnosis codes, resolving system edits, and coordinating with internal departments to update necessary files.

Responsible for the accurate and timely processing of claims by researching and processing according to regulations and internal standards. Requires resolving system edits and claims errors, while coordinating with departments to update necessary patient and provider files.

Supervises operations within the Subrogation and Workers' Compensation department to recover funds for the corporation. Responsibilities include performing quality control reviews, handling personnel issues, maintaining public relations, assisting staff on complex matters, and preparing reports.

As a Provider Enrollment Analyst, you'll manage the enrollment process for providers, ensuring applications are reviewed and processed correctly. This role involves verifying provider data, maintaining file integrity, and communicating effectively with clients. You'll assist with technical support, provider education, and participate in special projects related to enrollment processes.

The Financial Analyst I conducts and documents financial analysis projects, improves operational and financial effectiveness, extracts data from accounting systems, and interprets financial transactions. The role includes developing financial reports, assisting in policy development, and providing training for new hires.

The role involves identifying and pursuing subrogation and worker’s compensation recoveries, negotiating settlements, managing a caseload of around 400 cases, and providing training and supervision for new employees. It also includes analyzing laws and regulations related to claims and maintaining public relations with internal and external units.

The Quality Assurance Analyst will conduct quality control audits and reviews on departmental operations including claims and customer service. The role involves analyzing processes, providing feedback for improvements, documenting findings, and may include training new hires. Excellent analytical and communication skills are essential.

The Specialist in Subrogation identifies and manages approximately 500 cases for subrogation and workers compensation recoveries, analyzing relevant laws, negotiating settlements, and maintaining relationships with involved parties. Responsibilities include analyzing claims, negotiating with attorneys and liability carriers, and ensuring effective communication with internal and external units.

The Enrollment Representative I is responsible for processing membership applications, handling terminations and changes, updating databases, and resolving customer inquiries. The role includes preparing contracts and ID cards, working with membership transactions, and participating in projects related to enrollment and billing.

The Contract Compliance Manager oversees a compliance program to ensure regulatory requirements for insurance contracts are met. Responsibilities include negotiating contracts, ensuring regulatory approvals, conducting audits, responding to complaints, and managing staff involved in compliance tasks.

As a Financial Analyst III, you will provide key financial analysis and reports to support senior management, participate in projects to improve financial effectiveness, and perform financial and cost accounting analysis. You will handle complex data interpretation to assist management in decision-making and review financial statements and models while leading special projects.

The Specialist, Contract Compliance II will research and interpret insurance laws, prepare contract filings, review agreements, and ensure compliance with regulations. This role involves advising management on potential issues, maintaining corporate documents, and troubleshooting policy systems. Strong knowledge of insurance statutes and effective communication are essential for success in this position.

The Senior Buyer processes major requests for proposals (RFPs), developing new opportunities and partnerships while maximizing value and cost savings. Responsibilities include managing bids, building relationships with company staff, reporting workloads, and writing procedures to support workflows.