Claims Processor I

PGBA•Columbia, SC

12h•Onsite

About The Position

Responsible for the accurate and timely processing of claims. This position is full-time (40-hours/week) Monday-Friday from 8:00am-5:00pm in a typical office environment. This role is located on-site at 17 Technology Cir, Columbia, SC 29203. This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. To comply with the McNamara-O'Hara Service Contract Act (SCA), employees must enroll in our health insurance even if they have other health insurance. Employees will receive supplemental pay for health insurance until they are enrolled in our health insurance, first of the month following 28 days after the hire date.

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

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.