BlueCross BlueShield of South Carolina

About BlueCross BlueShield of South Carolina

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 70% 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. 15% Ensures that claims are processing according to established quality and production standards. Corrects processing errors by reprocessing, adjusting, and/or recouping claims. 15% 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. Required Education: High School Diploma or equivalent. Required Work Experience: Two 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. Additional Information: Position is onsite for 3-4 weeks of training. Position will move to a work at home position upon successful completion of training. Preferred Work Experience: Five years of experience processing and adjudicating claims. Medicare (Part A) Experience. Preferred Skills and Abilities: Strong time management skills. Knowledge of mathematical concepts. Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. 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 removed] 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.

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Company Info

Company Type: Nonprofit

Company Size: 1001 - 5000

Revenue: 0.5 - 1 billion (USD)

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Job Ads found: 5270

Job Ads per Month: 109.8

Hiring Locations: 28

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