Processor, Claims I

PGBA•Myrtle Beach, SC

14d•Onsite

About The Position

Logistics: PGBA - one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours 8am-6pm. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at on site at 8733 Highway 17 Bypass, Myrtle Beach SC 29575. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. SCA Benefit Requirements : SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act ( SCA ) . As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment. What You’ll Do: Research and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved references and investigative sources. Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.

Requirements

High School Diploma or equivalent.
Strong analytical, organizational and customer service skills.
Strong oral and written communication skills.
Proficient spelling, punctuation and grammar skills.
Good judgment skills.
Basic business math skills.
Basic office equipment.
This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Nice To Haves

1 year-of experience in a healthcare or insurance environment.
Ability to use complex mathematical calculations.
Proficient in word processing and spreadsheet applications.
Proficient in database software .

Responsibilities

Research and processes claims according to business regulation, internal standards and processing guidelines.
Verifies the coding of procedure and diagnosis codes.
Resolves system edits, audits and claims errors through research and use of approved references and investigative sources.
Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.