BlueCross BlueShield of South Carolina

SummaryWe are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South this role as Appeals Specialist you will perform non-medical reviews make requested corrections on submitted claims and complete appeal decision letters.Why should you join the BlueCross Bl

SummaryWe are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South this role as Appeals Specialist you will perform non-medical reviews make requested corrections on submitted claims and complete appeal decision letters.Why should you join the BlueCross Bl

SummaryDescriptionLocation:This role is onsite at our Myrtle Beach SC location. Fulltime 40 hours/weekGovernment Clearance: This position requires the ability to obtain a security clearance which requires applicants to be a U.S. Citizen.SCA Benefit Requirements: BlueCross BlueShield o

SummaryDescriptionLocation:This role is onsite at our Myrtle Beach SC location. Fulltime 40 hours/weekGovernment Clearance: This position requires the ability to obtain a security clearance which requires applicants to be a U.S. Citizen.SCA Benefit Requirements: BlueCross BlueShield o

SummaryWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance c

SummaryWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance c

SummaryProvides supervision of staff performing quality control activities for department or line business.DescriptionLogistics: National Alliance one of BlueCross BlueShields South Carolina subsidiary companies.Location: This hybrid position is full-time (40-hours/week) Monday-Frida

SummaryProvides supervision of staff performing quality control activities for department or line business.DescriptionLogistics: National Alliance one of BlueCross BlueShields South Carolina subsidiary companies.Location: This hybrid position is full-time (40-hours/week) Monday-Frida

SummaryResponsible for training activities in an assigned area(s). Note: some areas may require varying degrees of emphasis or concentration within this general description.DescriptionLogistics: () one of BlueCross BlueShields South Carolina subsidiary companies. Location: This posit

SummaryResponsible for training activities in an assigned area(s). Note: some areas may require varying degrees of emphasis or concentration within this general description.DescriptionLogistics: () one of BlueCross BlueShields South Carolina subsidiary companies. Location: This posit

SummaryWe have a job opening for the position of Summer Student Intern Actuarial position at BlueCross BlueShield of South Carolina. Intern position is utilized for training an active college student towards a professional-level role. The responsibilities vary and are based upon the

SummaryWe have a job opening for the position of Summer Student Intern Actuarial position at BlueCross BlueShield of South Carolina. Intern position is utilized for training an active college student towards a professional-level role. The responsibilities vary and are based upon the

SummaryAnalyzes current and proposed policies procedures systems forms and reports for the department. Analyzes existing processes and procedures to recommend operational improvement through standardization simplification discontinuance or other methods. May recommend installations o

SummaryAnalyzes current and proposed policies procedures systems forms and reports for the department. Analyzes existing processes and procedures to recommend operational improvement through standardization simplification discontinuance or other methods. May recommend installations o

SummaryProvides education and training support for network providers/staff/suppliers/physicians/beneficiaries/referral agents as necessary. Develops and produces training and educational materials.Why should you join the BlueCross BlueShield of South Carolina family of companies Other

SummaryProvides education and training support for network providers/staff/suppliers/physicians/beneficiaries/referral agents as necessary. Develops and produces training and educational materials.Why should you join the BlueCross BlueShield of South Carolina family of companies Other

SummaryBuilds and maintains effective long-term relationships with internal and external partners. Ensuring high levels of satisfaction and increase revenues through profitable new case pricing and drive renewal add issue sales. Supports reporting evaluation and additional development

SummaryBuilds and maintains effective long-term relationships with internal and external partners. Ensuring high levels of satisfaction and increase revenues through profitable new case pricing and drive renewal add issue sales. Supports reporting evaluation and additional development

SummaryPerforms quality control audits to evaluate accuracy and effectiveness of departmental operations functions including but not limited to claims membership customer service/call center workflow processing support systems procedures documentation etc. Identifies problems analyze

SummaryPerforms quality control audits to evaluate accuracy and effectiveness of departmental operations functions including but not limited to claims membership customer service/call center workflow processing support systems procedures documentation etc. Identifies problems analyze

SummaryWe have a job opening for the Consumer Experience and Market Solutions Summer Student Intern position with at BlueCross BlueShield of South Carolina. The Intern position is utilized for training an active high school or college student towards an entry level role. The responsi

SummaryWe have a job opening for the Consumer Experience and Market Solutions Summer Student Intern position with at BlueCross BlueShield of South Carolina. The Intern position is utilized for training an active high school or college student towards an entry level role. The responsi

SummaryPerforms validation reviews of Diagnosis Related Groups (DRG) Adaptive Predictive Coding (APC) and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports out

SummaryPerforms validation reviews of Diagnosis Related Groups (DRG) Adaptive Predictive Coding (APC) and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports out

SummaryResponsible for assisting in the execution of financial compliance and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans policies and procedures prescribed by management. Reviews assi

SummaryResponsible for assisting in the execution of financial compliance and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans policies and procedures prescribed by management. Reviews assi

SummaryResponsible for identifying training needs developing training materials and facilitating training. Provides training guidance and leadership for new training specialists. Develops performance assessments and testing materials. Manages trainees and communicates effectively with

SummaryResponsible for identifying training needs developing training materials and facilitating training. Provides training guidance and leadership for new training specialists. Develops performance assessments and testing materials. Manages trainees and communicates effectively with

SummaryWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance c

SummaryWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve been part of the national landscape for more than seven decades with our roots firmly embedded in the South Carolina community. We are the largest insurance c

SummaryWe are currently hiring for an Appeals Analyst to join BlueCross BlueShield of South this role as Appeals Analyst you will research the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Additionally you will

SummaryWe are currently hiring for an Appeals Analyst to join BlueCross BlueShield of South this role as Appeals Analyst you will research the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Additionally you will

SummaryDevelops comprehensive reports and analyzes data in order to identify patterns and trends. Assists in creating materials that aid in illustrating analytical/data findings. Assists with sophisticated data interpretation compilation and verification to guide departmental efforts.

SummaryDevelops comprehensive reports and analyzes data in order to identify patterns and trends. Assists in creating materials that aid in illustrating analytical/data findings. Assists with sophisticated data interpretation compilation and verification to guide departmental efforts.

SummaryResearches and resolves escalated complex and high profile claims issues. Serves as POC (point of contact) with various professional and facility/hospital providers in the research and resolution of all claims issues. May assist with escalated issues to include but not limited

SummaryResearches and resolves escalated complex and high profile claims issues. Serves as POC (point of contact) with various professional and facility/hospital providers in the research and resolution of all claims issues. May assist with escalated issues to include but not limited

SummaryProvides prompt accurate thorough and courteous responses to all customer inquiries. Inquires may be non-routine and require deviation from standard screens scripts and procedures. Performs research as needed to resolve inquiries.DescriptionLocation: This position is full-tim

SummaryProvides prompt accurate thorough and courteous responses to all customer inquiries. Inquires may be non-routine and require deviation from standard screens scripts and procedures. Performs research as needed to resolve inquiries.DescriptionLocation: This position is full-tim

SummaryPerforms varied clerical duties in accordance with standard procedures. This includes clerical duties such as photocopying compiling records filing tabulating posting information and distributing mail. Applies knowledge of department policies and procedures and utilizes a gener

SummaryPerforms varied clerical duties in accordance with standard procedures. This includes clerical duties such as photocopying compiling records filing tabulating posting information and distributing mail. Applies knowledge of department policies and procedures and utilizes a gener