Summary
 

Review and adjudicate complex or specialty claims. Determine whether to return, deny or pay claims following organizational policies and procedures. Assist in training or mentoring new staff members.

Description
 

Logistics:

This is a full-time (40 hours) W@H position. Training will be from 8am-5pm.

What You’ll Do:

• Examine and process complex or specialty claims according to business/contract regulations, internal standards and examining 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 processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims.

• Research and resolve claims edits and deferrals. Perform research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas. Respond to routine correspondence and completes spreadsheet 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.

What We Prefer:

• 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.

What We Can Do for You:

• 401(k) retirement savings plan with company match.

• Subsidized health plans and free vision coverage.

• Life insurance.

• Paid annual leave – the longer you work here, the more you earn.

• Nine paid holidays.

• On-site cafeterias and fitness centers in major locations.

• Wellness programs and healthy lifestyle premium discount.

• Tuition assistance.

• Service recognition.

• Incentive Plan.

• Merit Plan.

• Continuing education funds for additional certifications and certification renewal.

What to Expect Next:

After you submit 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.

Management will conduct interviews with the most qualified candidates, prioritizing those who demonstrate the preferred qualifications.

 

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

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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.