Claims Processor I

PGBA•Florence, SC

1d•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 over seven decades and is the largest insurance company in South Carolina. They are also a leading administrator of government contracts and operate a sophisticated data processing center. This role is with PGBA, a subsidiary company, and is located on-site at 200 N Dozier Blvd, Florence, SC 29501. This position requires the ability to obtain a security clearance and applicants must be U.S. Citizens. Due to federal government contracts, employees must enroll in the company's health insurance, even if they have other coverage, and will receive supplemental pay for health insurance until enrollment.

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.
Must be a U.S. Citizen to obtain a security clearance.

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.