Claims Processor II
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Job Location:
Columbia, IN - USA
Monthly Salary:
Not Disclosed
Posted on:
30+ days ago
Vacancies:
1 Vacancy
Job Summary
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 one of BlueCross BlueShields South Carolina subsidiary companies
Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm. This role is located on-site at 17 Technology Circle Columbia SC 29203.
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 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:
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 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: Microsoft Office.
We Prefer That You Have the Following:
Preferred Work Experience: 1 years of claims processing experience.
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.
Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for 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.
Key Skills
- Loan Processing
- Typing
- Data Entry
- Customer Service
- Organizational skills
- Basic Math
- Computer Skills
- Fraud
- Microsoft Outlook
- 10 Key Calculator
- Fair Housing Regulations
- Food Processing
About Company
You can’t reach new heights of performance unless you’re willing to invest in others. That people-first mantra has been our guiding light since we started in the Medicare business in 1965. Headquartered in Columbia, S.C., and with offices in Augusta, Ga.; Birmingham, Ala.; Camden, S.C ... View more
