SUMMARY

We are currently hiring for a Claims Processor II to join BlueCross BlueShield of South Carolina. In this role as Claims Processor II, you will be responsible for reviewing and adjudicating complex or specialty claims. You will determine whether to return, deny or pay claims following organizational policies and procedures. You will also assist in training or mentoring new staff members.
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!
Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

DESCRIPTION

Logistics: Planned Administrators Inc. (PAI) – one of BlueCross BlueShield’s South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am-4:30pm and will be fully remote . The candidate may be asked to come on-site for training, meetings, or other business needs. Candidates must reside within a one-hour commute of the Columbia location.

TO QUALIFY FOR THIS POSITION, YOU’LL NEED THE FOLLOWING:

• Required Education: High School Diploma or equivalent
• Required Work Experience: 2 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.

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 mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 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

• 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.