Manager, Claims Operations

BlueCross BlueShield of South Carolina•Augusta, GA

22h•Onsite

About The Position

Manages a team of associates responsible for the accurate and timely processing and adjudication of claims. This position is full-time (40-hours/week) Monday-Friday in a typical office environment, with an 8-hour shift scheduled during normal business hours of 8:30AM-5:30PM. The role is located at 2743 Perimeter Parkway, Augusta, GA 30909. Palmetto GBA is one of BlueCross BlueShield's South Carolina subsidiary companies. The company values a diverse and inclusive workplace, aiming to be an employer where employees can develop skills, advance careers, and contribute their unique abilities. BlueCross BlueShield of South Carolina has been established for over seven decades, with strong roots in the South Carolina community. It holds an A+ (Superior) A.M. Best rating, is the largest insurance company in South Carolina, a leading administrator of government contracts, and operates a sophisticated data processing center. The company also has a diverse family of subsidiary companies and is a strong supporter of veterans, offering pay coverage for full-time National Guard or Reserves called to active duty.

Requirements

Bachelor's Degree (Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience, except for Celerian Group where Bachelor's degree is required).
4 years of claims processing experience, including either 2 years of lead or supervisory experience OR 2 years of equivalent military experience in grade E4 or above.
Analyzes claims deferrals.
Diagnoses claims issues.
Enters claims data.
Reviews work from others.
Uses sound reasoning when processing claims.

Nice To Haves

Microsoft Office

Responsibilities

Monitors and evaluates one or more units to ensure the accurate and timely processing of claims.
Develops effective claims processing standards that incorporate the use of automated claims systems and other technology solutions.
Ensures compliance with all applicable laws, regulations, and contract requirements while meeting performance expectations.
Monitors all reports and quality audits to ensure the efficient operation of the department.
Ensures proper training for new and current staff.
Maintains a high level of customer service with all internal and external customers.
Interacts regularly with internal departments for planning, training, and management purposes.