Claims Examiner

1 week ago

Florence, South Carolina, United States BlueCross BlueShield of South Carolina Full time
Job Summary

We are seeking a skilled Claims Processor II to join our team at BlueCross BlueShield of South Carolina. As a Claims Processor II, you will play a critical role in reviewing and adjudicating complex or specialty claims, ensuring that they are processed in accordance with organizational policies and procedures.

Key Responsibilities
  • Examine and process complex or specialty claims according to business/contract regulations, internal standards, and examining guidelines.
  • Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.
  • Verify that claims have been keyed correctly and ensure that they 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, utilizing policies, procedures, reference materials, and coordinating with various internal support areas.
  • Respond to routine correspondence and complete spreadsheets as applicable.
Requirements
  • High School Diploma or equivalent.
  • Two years of experience processing, researching, and adjudicating claims.
  • 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.
Preferred Qualifications
  • Microsoft Office proficiency.

We are an Equal Opportunity Employer and participate in E-Verify. 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 email or call, ext with the nature of your request.

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