Claims Processor II

BlueCross BlueShield of South Carolina•Columbia, SC

23h•Hybrid

About The Position

Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members. This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. This role is a Work-at-Home (W@H) position after equipment issuance, performance evaluation and Line of Business (LOB) needs evaluation. Training is on site at 4101 Percival Road, Columbia SC for 4-6 weeks between 8am to 4:30pm/5:00pm.

Requirements

High School Diploma or equivalent
2 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

Nice To Haves

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

Responsibilities

Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
Verifies that claims have been keyed correctly.
Ensures that claims are processing according to established quality and production standards.
Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
Researches and resolves claims edits and deferrals.
Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
Responds to routine correspondence and completes spreadsheet if applicable.
Assists in training or mentoring new staff members.