Claims Processor II

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Onsite

About The Position

Reviews and adjudicates complex or specialty claims, determining whether to return, deny, or pay claims in accordance with organizational policies and procedures. The role also assists with 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 8-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, SC 29203. The position is not eligible for sponsorship now or in the future.

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.
Proficiency in spelling, punctuation, and grammar.
Proficiency 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 the correct coding of procedures and diagnosis codes.
Verify that claims have been 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 various internal support areas.
Respond to routine correspondence and complete spreadsheets, if applicable.
Assist in training or mentoring new staff members.