Claims Processor Ii (W@H South Carolina)

Summary

We are currently hiring for a Claims Processor II to join BlueCross BlueShield of South Carolina. In this role as Claims Processor II, you will be responsible for reviewing and adjudicating complex or specialty claims. You will determine whether to return, deny or pay claims following organizational policies and procedures. You will also assist in training or mentoring new staff members.

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 have 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 committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description

Logistics

This position is full time (40 hours/week) Monday-Friday and will be W@H in Columbia S.C.

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.
• 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.
• Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims.

To Qualify For This Position, You Will Need

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

What We Can Do for You

• Paid annual leave – the longer you work here, the more you earn.
• Subsidized health plans and free vision coverage.
• Service recognition.
• Tuition assistance.
• Incentive Plan.
• Continuing education funds for additional certifications and certification renewal.
• Merit Plan.
• Life insurance.
• 401(k) retirement savings plan with company match.
• On-site cafeterias and fitness centers in major locations.
• Nine paid holidays.
• Wellness programs and healthy lifestyle premium discount.

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.

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.