Claims Processor II

BlueCross BlueShield of South Carolina

1d•Remote

About The Position

We are currently hiring for a Claims Processor II to join BlueCross BlueShield of South Carolina. In this role as Claims Processor II, you will be responsible for reviewing and adjudicating complex or specialty claims. You will determine whether to return, deny or pay claims following organizational policies and procedures. You will also assist in training or mentoring new staff members. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team! Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future. Description Logistics: Planned Administrators Inc. (PAI)– one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am-4:30pm and will be fully remote. The candidate may be asked to come on-site for training, meetings, or other business needs. Candidates must reside within a one-hour commute of the Columbia location.

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.
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.