Processor, Claims II

BlueCross BlueShield of South Carolina

8d•Hybrid

About The Position

Position Purpose: Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Logistics: National Alliance – one of BlueCross BlueShield of South Carolina’s subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-4:30PM. Hybrid/remote schedule may become available after initial training and the ability to maintain acceptable performance metrics. Due to the hybrid nature of the schedule, qualified local candidates within commuting distance of 4101 Percival Rd., Columbia, SC 29229 are encouraged to apply.

Requirements

High School Diploma or equivalent
2 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.
Microsoft Office.

Nice To Haves

5 years-of experience processing and adjudicating claims.
Strong time management skills.
Knowledge of mathematical and statistical concepts.
Proficient in word processing and spreadsheet applications.
proficient database software skills.

Responsibilities

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