National Allianceone of BlueCross BlueShields South Carolina subsidiary companies.

This position is full time (40 hours/week) Monday-Friday and will be fully remote (South Carolina )

One week of onsite training required at 4101 Percival Rd Columbia SC 29229 followed by three weeks of remote training with the team

What Youll Be Doing:

This role is all about reporting! Youll be pulling data from multiple Blue Cross systems (Rumba Blueview Cohere) and creating detailed reports that summarize member healthcare spending and high-cost claims. Its a very structured repetitive rolethink consistent daily tasks with clear processes and deadlines. If you thrive on routine and accuracy youll do great here!

• Proficient in Excel (this is a mustyoull be working in spreadsheets daily!)

• Detail-oriented with strong written communication skills

• Self-motivated and excellent at time management

What You Will Do:

• Maintains the outpatient authorization process to include ensuring benefit coverage reviewing/determining eligibility reviewing of established utilization review criteria interpreting rules/regulations.

• Completes authorization by following established policies/procedures.

• Reviews interdepartmental requests and medical information to complete utilization process.

• Documents process used and decision in the appropriate system in accurate/timely manner.

• Establishes/maintains effective business relationships with primary care physician offices other providers of health services.

To Qualify for This Position You Will Need:

• Graduate of Accredited School of Licensed Practical Nursing OR Licensed Vocational Nursing.

• Three years managed care in healthcare physicians office OR insurance company setting.

• Ability to work independently prioritize effectively and make sound decisions.

• Good judgment skills.

• Demonstrated customer service and organizational skills.

• Demonstrated oral and written communication skills.

• Ability to handle confidential OR sensitive information with discretion.

• Active unrestricted LPN/LVN licensure from the United States and in the state of hire OR active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC).

• Microsoft Office.

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.

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.