Claims Processor I

7 days ago

North Myrtle Beach, South Carolina, United States PGBA, Full time $40,000 - $60,000 per year

Summary
 Responsible for the accurate and timely processing of claims.
Description
 

Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. This role is located on-site at 8733 Highway 17 Bypass South Bldg. 200, Myrtle Beach, SC 29575.

  • Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. 
  • SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. 

What You'll Do:

  • Research and process claims according to business regulation, internal standards and processing guidelines. Verify the coding of procedure and diagnosis codes.
  • Resolve system edits, audits and claim errors through research and use of approved references and investigative sources.
  • Coordinate with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.

To Qualify For This Position, You'll Need The Following:

  • Required Education: High School Diploma or equivalent
  • Required Skills and Abilities: Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math skills.

We Prefer You Have:

  • Ability to use complex mathematical calculations.
  • 1 year of experience in a healthcare or insurance environment.
  • Proficient in word processing and spreadsheet applications. Proficient in database software.

Our Comprehensive Benefits Package Includes The Following:

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
  • 401k retirement savings plan with company match
  • Life Insurance
  • Paid Time Off (PTO)
  • On-site cafeterias and fitness centers in major locations
  • Education Assistance
  • Service Recognition
  • National discounts to movies, theaters, zoos, theme parks and more

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

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 our recruiter to verify resume specifics and salary requirements.

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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email  or call , ext with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

Some states have required notifications. Here's more information. 

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