EDI Operations Associate II - Palmetto GBA

BlueCross BlueShield of South Carolina•Columbia, SC

8d•Onsite

About The Position

Palmetto GBA is one of the nation’s largest providers of high-volume claims and transaction processing, contact center operations, and technical services to the federal government and other commercial customers. Our core business is providing services to CMS Medicare beneficiaries, providers, and health plans. Palmetto GBA is one of the few Medicare contractors with experience in all Medicare business segments – Medicare Part A, Medicare Part B, Durable Medical Equipment (DME), Home Health and Hospice (HHH), and Medicare Advantage (MA) Part C and Part D. This broad experience base offers CMS a contractor with unique expertise and the ability to offer customized, creative, and proven solutions to complex problems. This position provides first and second level technical support to a variety of customers comprising the submitter community, as well as basic internal support via analysis and research into EDI-related issues as required by business contracts.

Requirements

Associate's in a job related field.
4 total years required work experience.
2 years of applicable EDI experience.
Good system research and analysis skills.
Working knowledge of relevant EDI software and tools used by the company/contract.
Good organizational, judgment, customer service, and both verbal and written communication skills.
Good spelling, punctuation, and grammar skills.
Basic math and computer skills.
Ability to handle confidential or sensitive information with discretion.
Microsoft Office.

Nice To Haves

Experience working on MAC Contracts.
Experience handling remits on GP Claims and Front-end rejections.
Medicare experience.
Experience with EDI enrollments pertaining to Medicare
3 years-of applicable EDI experience.

Responsibilities

Provides quality/timely internal/external customer technical support/service for variety of insurance contracts as assigned.
Support of communication interfaces/transactions/functions as required by insurance laws (such as support of claims, remit advice, inquiry/response for claims status/eligibility, enrollment, premium payment etc.).
Support of all current formats/transactions required by law/BCBSSC lines of business.
Responsible for the setup of all electronic transactions submission by processing enrollment applications, updating associated system files, and managing customer notification.