Logistics: Palmetto GBA one of BlueCross BlueShields South Carolina subsidiary companies.

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 17 Technology Circle Columbia SC 29203.

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 McNamara-OHara 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:

• Obtains necessary information (written notifications faxes emails or telephone contacts) and establishes certification of healthcare service providers.
• Prepares provider files/maintains provider data (updates additions deletions) on the provider information management system (PIMS)or appropriate provider systems/database.
• Generates and analyzes various provider reports to management.
• Assists with providing technical support through system testing to ensure system enhancements/modifications.
• Researches/resolves issues/problems from providers related to eligibility recertifications edits billing etc.
• Contributes to departments production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.
• Contributes to and participates on special projects which may include but are not limited to the following: mass rate updates quality improvement audits etc.

To Qualify for This Position Youll Need the Following:

• Required Education: High School Diploma or equivalent.
• Required Experience: 3 years of experience in customer service claims processing and/or provider network certification or combination
• Required Software and tools: Microsoft Office. Working knowledge of DB2 or other database software.
• Required Skills and Abilities: Working knowledge of word processing spreadsheet and database software. Knowledge/understanding of PIMS and -depth knowledge of provider certification process claims processing operations/-depth knowledge of pricing methodology and discount programs. Good judgment skills. Demonstrated verbal and written communication skills. Demonstrated proficiency in spelling punctuation and grammar skills. Basic business math proficiency and knowledge of mathematical or statistical concepts. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion.

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)
• On-site cafeterias and fitness centers in major locations
• Education Assistance
• Service Recognition
• National 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

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.