Processor, Claims I

PGBA,•Columbia, SC

3d•Onsite

About The Position

Responsible for the accurate and timely processing of claims. The role researches and processes claims according to business regulations, internal standards, and processing guidelines; verifies procedure and diagnosis code coding; and resolves system edits, audits, and claims errors through research and approved references and investigative sources. It coordinates with internal departments to address edits and deferrals, updating patient identification, other health insurance, provider identification, and other files as needed. This is a full-time, 40-hour-per-week position, Monday through Friday, 8:00 a.m. to 5:00 p.m., in a typical office environment. The role is on-site at 17 Technology Cir, Columbia, South Carolina. It is with PGBA, a BlueCross BlueShield of South Carolina subsidiary. Applicants must be U.S. citizens and able to obtain a security clearance. The position is not eligible for sponsorship now or in the future. As an employee working on contracts subject to the Service Contract Act, enrollment in the company’s health insurance is required, even if the employee already has other health insurance. Supplemental pay for health coverage is provided until enrollment is complete; coverage begins on the first day of the month following 28 days of full-time employment.

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 skills.
Must be a U.S. citizen and able to obtain a security clearance.
Must enroll in the company health insurance plan as an SCA employee.

Nice To Haves

Ability to use complex mathematical calculations.
Claims processing experience.
Proficiency in word processing and spreadsheet applications.
Proficiency in database software.

Responsibilities

Research and process claims according to business regulations, internal standards, and processing guidelines.
Verify the coding of procedure and diagnosis codes.
Research and resolve system edits, audits, and claims errors using approved references and investigative sources.
Coordinate with internal departments to address edits and deferrals.
Update patient identification, other health insurance, provider identification, and other files as necessary.