Claims Processing 1-24

PGBA•Florence, SC

2d•Onsite

About The Position

Responsible for the accurate and timely processing of claims. The role researches and processes claims according to business regulations, internal standards, and processing guidelines. It verifies procedure and diagnosis coding, resolves system edits, audits, and claims errors through research and approved references, and coordinates with internal departments to work edits and deferrals. The position may update patient identification, other health insurance, provider identification, and other files as necessary. This full-time, on-site role is with PGBA, a subsidiary company of BlueCross BlueShield of South Carolina, at 200 N Dozier Blvd., Florence, SC 29501. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. The position is subject to Service Contract Act benefit requirements; employees cannot opt out of health benefits and receive supplemental pay until enrolled in health benefits 28 days after hire. Sponsorship is not available now or in the future.

Requirements

High school diploma or equivalent.
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.

Nice To Haves

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

Responsibilities

Research and process claims according to business regulations, internal standards, and processing guidelines.
Verify procedure and diagnosis code coding.
Resolve system edits, audits, and claims errors using research, approved references, and investigative sources.
Coordinate with internal departments to work edits and deferrals.
Update patient identification, other health insurance, provider identification, and other files as necessary.