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Position Purpose:
In the role as a Claims Processor II, the ideal candidate will be able to review and adjudicate complex or specialty claims. One will also determine whether to return, deny, or pay claims following organizational policies and procedures as well as assist in training or mentoring new staff members.
Description
Claims Processor II
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've 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 dedicated to the same philosophy, consider joining our team!
Logistics:
This position is a full-time position (40 hours per week) Monday through Friday. Training hours will be 8:00 AM - 4:30 PM CST reporting onsite. Upon completion of training, employees are required to have the flexibility to work any 8-hour shift during the hours of 6:00 AM - 6:00 PM your time zone reporting onsite to 17 Technology Circle, Columbia, SC 29203 OR 26 Century Blvd Suite ST610 Nashville, Tennessee, 37214.
What You'll Do:
To Qualify for This Position, You'll Need:
We Prefer That You Have:
What We can Do for You:
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.
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. If the qualifications require proof of semester hours, please attach your transcript to your application.
Management will be conducting interviews with the most qualified candidates, 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 mycareer.help@bcbssc.com 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.
Position Purpose:
In the role as a Claims Processor II, the ideal candidate will be able to review and adjudicate complex or specialty claims. One will also determine whether to return, deny, or pay claims following organizational policies and procedures as well as assist in training or mentoring new staff members.
Description
Claims Processor II
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've 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 dedicated to the same philosophy, consider joining our team!
Logistics:
This position is a full-time position (40 hours per week) Monday through Friday. Training hours will be 8:00 AM - 4:30 PM CST reporting onsite. Upon completion of training, employees are required to have the flexibility to work any 8-hour shift during the hours of 6:00 AM - 6:00 PM your time zone reporting onsite to 17 Technology Circle, Columbia, SC 29203 OR 26 Century Blvd Suite ST610 Nashville, Tennessee, 37214.
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
- Correct 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
- Microsoft Office
We Prefer That You Have:
- 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:
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 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. If the qualifications require proof of semester hours, please attach your transcript to your application.
Management will be conducting interviews with the most qualified candidates, 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 mycareer.help@bcbssc.com 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.
