Claims Processor I

PGBA,•Florence, SC

2d•Onsite

About The Position

Responsible for the accurate and timely processing of claims. BlueCross BlueShield of South Carolina has been part of the national landscape for more than seven decades, with roots firmly embedded in the South Carolina community. They are the largest insurance company in South Carolina and a leading administrator of government contracts, operating a sophisticated data processing center. They have a diverse family of subsidiary companies and are dedicated to delivering outstanding service to their customers.

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

Ability to use complex mathematical calculations.
Proficient in word processing and spreadsheet applications.
Proficient in database software.

Responsibilities

Researches and processes claims 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.