Summary
 

As a Provider File Specialist I, you will be responsible for establishing and maintaining certification and / or preparation, review and / or maintenance of healthcare provider files in support of provider directories, accurate and timely claims adjudication, and provider billing.

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 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 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:

This position is a Work at Home (W@H) position. The hours are 8:00 a.m. – 5:00 p.m. Monday – Friday.

What You’ll Do:

• Verify necessary information (written notifications, faxes, emails, or telephone contacts) and / or establish certification of healthcare service providers.
• Prepare provider files and maintain provider data (updates, additions, deletions) on the provider information management system (PIMS) or appropriate provider system / database.
• Identify and assign providers to the appropriate network and provider system / database.
• Contribute to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system / database maintenance / error reports.
• Contribute 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:

• High School Diploma or equivalent.
• 1 year of administrative / clerical support, customer service, claims processing, and / or provider network / certification experience.
• 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.
• Experience with Microsoft Office.

What We Prefer:

• Ability to learn DB2, SQL language to create / run PIMS queries for QC / research purposes.

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 submitting your application, our recruiting team members will review your resume to ensure your 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 be conducting interviews with the most qualified candidates, with prioritization give 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.