Claims Processor II

Summary
 As a Claims Processor II, you will review and adjudicate complex or specialty claims. Following organizational policies and procedures, you will determine whether to return, deny, or pay claims. You will assist in training or mentoring new staff members. You will screen, code, and key claims in the claims system. You will also ensure claims are processed in a timely manner.
Description
 

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 have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina, among many others. 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 various business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure community roots and an innovative future.

Logistics: PGBA – one of BlueCross BlueShield's SC subsidiary companies.

Location:

This position is full time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility work any our 8-hour shift scheduled during hours of 8:00 AM –8:00 PM. Training will be Monday – Friday 8:00 AM -4:30/5:00 PM for approximately 6-8 weeks. This role is located on site at 17 Technology Circle, Columbia SC. 

***This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. ***

What You’ll Do:

• Examine and process complex or specialty claims according to business/contract regulations and internal standards, as well as examine guidelines.

• Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.

• Verify that claims have been keyed correctly.

• Ensure that claims are processed according to established quality and production standards.

• Correct processing errors by reprocessing, adjusting, and/or recouping claims.

• Research and resolve claims edits and deferrals.

• Performs research on claim problems by utilizing policies, procedures, reference materials and forms and coordinates with various internal support areas.

• Respond to routine correspondence and complete spreadsheets if applicable.

To Qualify for This Position, You’ll Need:

• High School Diploma or equivalent

• 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.

• Experience with Microsoft Office.

We Prefer That You Have the Following:

• 5 years of experience processing and adjudicating claims.

• Strong time management skills.

• Knowledge of mathematical and statistical concepts.

• Proficient in word processing and spreadsheet applications. proficient database software skills.

Our comprehensive benefits package includes the following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits 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

• Wellness program and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Employee Assistance

• 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 a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

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

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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, 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.