Claims Processor II
Claims Processor II
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Not Disclosed
Salary Not Disclosed
1 Vacancy
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
Logistics:
PGBA is a subsidiary company of BlueCross BlueShield of South Carolina.
Location:
This position is full time 40 hours/week) MondayFriday in a typical office environment. Employees are required to have flexibility work any our 8hour shift scheduled during hours of 8:00 AM 5:00 PM. Training will be Monday Friday 8:00 AM 4:30/5:00 PM for approximately 68 weeks. This role is located on site at 8733 Highway 17 Bypass Myrtle Beach SC.
- Government 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 of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamaraOHara Service Contract Act (SCA) employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
What Youll Do:
- Examines 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
To Qualify for This Position Youll Need the Following:
- Required Education:
- High School Diploma or equivalent
- Required Work Experience:
- 2 years of experience processing research and adjudicating claims.
- Required Skills and Abilities:
- 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.
- Required Software and Tools:
- Microsoft office
We Prefer That You Have the Following:
- 5 yearsof 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
Our Comprehensive Benefits Package Includes the Following:
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)
- Onsite 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 We can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills advance their careers and contribute their unique abilities to the growth of our company.
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 conduct interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the required 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.
Employment Type
Full-Time
