Claims Processor I

PGBA,•Columbia, SC

15h•Onsite

About The Position

Responsible for the accurate and timely processing of claims. This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment, located on-site at 17 Technology Cir, Columbia, SC 29203. This role requires the ability to obtain a security clearance, which necessitates applicants to be U.S. Citizens. Due to compliance with the McNamara-O'Hara Service Contract Act (SCA), employees must enroll in the company's health insurance, even if they have other health insurance, and will receive supplemental pay for health insurance until enrolled. PGBA, LLC, a subsidiary of BlueCross BlueShield of South Carolina, is a leading provider of administrative services for the TRICARE health benefit program and health benefit programs of Veteran’s Health Administration for both state and federal governments. The company has offices in Florence, Surfside Beach, and Columbia, South Carolina, and fosters an atmosphere conducive to growth and personal and professional development with a diverse workforce.

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.
Basic office equipment.
Ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Nice To Haves

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

Responsibilities

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