Claims Processor II

BlueCross BlueShield of South Carolina•Columbia, SC

3d•Onsite

About The Position

Reviews and adjudicates complex or specialty claims, determining whether claims should be returned, denied, or paid in accordance with organizational policies and procedures. Examines and processes claims according to business and contract regulations, internal standards, and examining guidelines. Enters claims into the claim system after verifying procedure and diagnosis coding, and confirms claims were keyed correctly. Ensures claims meet established quality and production standards and corrects processing errors through reprocessing, adjustments, or recoupments. Researches and resolves claim edits, deferrals, and other claim problems using policies, procedures, reference materials, and forms, coordinating with internal support areas as needed. Responds to routine correspondence and completes spreadsheets when applicable. Assists in training or mentoring new staff members. This is a full-time, 40-hour-per-week position, Monday through Friday, in a typical office environment. The employee works an eight-hour shift scheduled during normal business hours of 8:00 a.m. to 5:00 p.m. The position is located at 17 Technology Cir, Columbia, South Carolina 29203. The position is not eligible for current or future sponsorship.

Requirements

High school diploma or equivalent.
Two years of experience processing, researching, and adjudicating claims.
Strong organizational, analytical, and judgment skills.
Strong oral and written communication skills.
Proficient in spelling, punctuation, and grammar.
Proficient in basic business math.
Ability to handle confidential or sensitive information with discretion.
Microsoft Office skills.

Nice To Haves

Two years of claims processing experience.
Strong time-management skills.
Knowledge of mathematical and statistical concepts.
Proficiency in word-processing and spreadsheet applications.
Proficient database software skills.

Responsibilities

Examine and process complex or specialty claims according to business and contract regulations, internal standards, and examining guidelines.
Enter claims into the claim system after verifying correct procedure and diagnosis coding, and verify that claims were keyed correctly.
Ensure claims are processed according to established quality and production standards.
Correct processing errors by reprocessing, adjusting, and/or recouping claims.
Research and resolve claims edits and deferrals.
Research claim problems using policies, procedures, reference materials, and forms, and coordinate with internal support areas.
Respond to routine correspondence and complete spreadsheets when applicable.
Assist in training or mentoring new staff members.