Claims Processor II
Claims Processor II
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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: This is a full-time position (40HPW). The ideal candidate will work on-site at our Florence SC location.
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). To comply with the McNamara-OHara Service Contract Act (SCA) employees must enroll in our health insurance even if they have other health insurance. Employees will receive supplemental pay for health insurance until they are enrolled in our health insurance first of the month following 28 days after the hire date.
What You Will 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.
We Require You to Have:
Required Education: High School Diploma or equivalent.
Required Work Experience: 2 years of experience processing researching 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: Proficiency with all Microsoft Office Products.
We Prefer You Have:
Preferred Work Experience: 5 years-of experience processing and adjudicating claims.
Preferred Skills and Abilities: Strong time management skills. Knowledge of mathematical and statistical concepts.
Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. proficient database software skills.
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 you meet the qualifications. This may include a brief telephone interview or email communication with a 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 E-Verify 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 e-mail or call 1- ext. 47480 with the nature of your request. We will decide regarding your request for reasonable accommodation on a case-by-case basis.
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 individuals with disabilitiesand protected 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 disabilities pregnant individuals individuals with pregnancy-related conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment please email or call 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.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.
Some states have required notifications. Heres more information.
Employment Type
Full-Time
