Claims Processor Ii (Part-Time)

Summary

Position Purpose:

In the role as a Claims Processor II, the ideal candidate will be able to resolve claims at a high volume and be responsible for reviewing and adjudicating complex or specialty claims. One will determine whether to return, deny, or pay claims following organizational policies and procedures. The ideal candidate will also be able to assist in training or mentoring new staff members.

Description

Claims Processor II (Part-Time)

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Logistics

This position is part-time position Monday through Friday. Training hours will be 8:30am – 5:00pm reporting onsite to 1000 Executive Center Drive, Greenville, SC 29616 for approximately 6 months. Upon completing training, and meeting departmental standards, there will be an opportunity to work remote.

What You’ll Do

• Examine and process complex or specialty claims according to business/contract regulations, internal standards and examining guidelines
• Ensure that claims are processing according to established quality and production standards
• Correct processing errors by reprocessing, adjusting, and/or recouping claims
• Research and resolve claims edits and deferrals
• Verify that claims have been keyed correctly
• Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes
• Respond to routine correspondence and completes spreadsheet if applicable
• Perform research on claim problems by utilizing policies, procedures, reference materials, forms, and coordinates with various internal support areas

To Qualify For This Position, You’ll Need

• 2 years of experience processing, researching, and adjudicating claims
• High School Diploma or equivalent
• Ability to handle confidential or sensitive information with discretion
• Proficient in basic business math
• Strong organizational, analytical and judgment skills
• Proficient in spelling, punctuation, and grammar
• Microsoft Office
• Strong oral and written communication skills

We Prefer That You Have

• Strong time management skills
• Proficient database software skills
• 5 years-of experience processing and adjudicating claims
• Knowledge of mathematical and statistical concepts
• Proficient in word processing and spreadsheet applications
• CES, CORDS, OR AMMS experience

What We Can Do For You

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
• Paid Time Off (PTO)
• Wellness program and healthy lifestyle premium discount
• Discounts to movies, theaters, zoos, theme parks and more
• Employee Assistance
• 401K retirement savings plan with company match
• On-site cafeterias and fitness centers in major locations
• Tuition assistance
• Life Insurance
• Service recognition

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications require proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, 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.

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 [email protected] or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.