Claims Processor I

PGBA•Florence, SC

1d•Onsite

About The Position

Responsible for the accurate and timely processing of claims. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm. This role is located on-site at 200 N Dozier Blvd., Florence, SC 29501. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. What You’ll Do: 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.

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.

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

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.