Claims Processor II

Job Summary

As a Claims Processor II at BlueCross BlueShield of South Carolina, you will play a critical role in reviewing and adjudicating complex or specialty claims. Your attention to detail and analytical skills will be essential in determining whether to return, deny, or pay claims. You will also assist in training or mentoring new staff members and ensure claims are processed in a timely manner.

About the Role

This position is located at 160 Dozier Boulevard, Florence, SC, and operates from 8:00 a.m. to 5:00 p.m., Monday through Friday. Your primary responsibilities will include examining and processing complex or specialty claims according to business/contract regulations and internal standards. You will 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 claims are processed according to established quality and production standards. You will also correct processing errors by reprocessing, adjusting, and/or recouping claims, research and resolve claims edits and deferrals, and perform research on claim problems by utilizing policies, procedures, reference materials and forms and coordinates with various internal support areas. Additionally, you will respond to routine correspondence and complete spreadsheets if applicable.

Requirements

To be successful in this role, you will need a High School Diploma or equivalent and 2 years of experience processing, researching, and adjudicating claims. You will also require strong organizational, analytical, and judgment skills, as well as strong oral and written communication skills. Proficiency in spelling, punctuation, and grammar, as well as basic business math, is also essential. You will also need to be able to handle confidential or sensitive information with discretion and have experience with Microsoft Office. While 5 years of experience processing and adjudicating claims is preferred, we encourage candidates with relevant experience to apply.

What We Offer

As a valued member of our team, you can expect a competitive compensation package, including a 401(k) retirement savings plan with company match, subsidized health plans, and free vision coverage. You will also have access to life insurance, paid annual leave, nine paid holidays, on-site cafeterias and fitness centers in major locations, wellness programs, and healthy lifestyle premium discounts. We also offer tuition assistance, service recognition, an incentive plan, a merit plan, and continuing education funds for additional certifications and certification renewal. 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.

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