Claims Processor II
Claims Processor II
Employer Active
Job Alert
You will be updated with latest job alerts via email
Share
Job Alert
You will be updated with latest job alerts via email
Job Description
Summary
Reviews and adjudicates complex or specialty claims. Determines whether to return deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.
Description
What You Will Do:
- Examine and processes complex or specialty claims according to business/contract regulations internal standards and examining guidelines.
- Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
- Verifies that claims have been keyed correctly.
- Ensures that claims are processing according to established quality and production standards.
- Corrects processing errors by reprocessing adjusting and/or recouping claims.
- Researches and resolves claims edits and deferrals.
- Performs research on claim problems by utilizing policies procedures reference materials forms and coordinates with various internal support areas.
- Responds to routine correspondence and completes spreadsheet if applicable.
You Are Required To have:
- High School Diploma or equivalent.
- Two years of experience processing researching and adjudicating claims.
- Five Years of Onbase PreScreen Verification processing. (May be concurrent with other work experience).
- 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.
- Strong time management skills.
- Knowledge of mathematical and statistical concepts.
- Proficient with Microsoft Office Applications and products.
We Prefer You to Have:
- Proficient in word processing and spreadsheet applications
- Proficient in database software skills.
What Blue Can Do for You:
Our comprehensive benefits package includes:
- 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.
- Onsite cafeterias and fitness centers in major locations.
- Wellness Programs and a Healthy Lifestyle Premium Discount.
- Tuition Assistance.
- Service Recognition.
- Realistic career advancement opportunities.
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 our 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 EVerify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Heresmore 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 email or callext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a casebycase basis.
We participate in EVerify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Heresmore 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 email or callext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a casebycase basis.
Employment Type
Full-Time
