Processor, Claims I

PGBA•Myrtle Beach, SC

2d•Onsite

About The Position

Responsible for accurately and promptly processing claims for PGBA, a BlueCross BlueShield of South Carolina subsidiary. The role researches and processes claims in accordance with business regulations, internal standards, and processing guidelines; verifies procedure and diagnosis coding; and resolves claim edits, audits, and errors using approved references and investigative sources. It also coordinates with internal departments to address edits and deferrals and updates patient identification, other health insurance, provider identification, and related files as needed. This is a full-time, on-site position in a typical office environment at 8733 Highway 17 Bypass, Myrtle Beach, South Carolina. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m. The position requires the ability to obtain a security clearance, which requires U.S. citizenship. Sponsorship is not available now or in the future. As a Service Contract Act employee, the employee must enroll in the company’s health insurance, even if already covered elsewhere. Coverage begins on the first day of the month following 28 days of full-time employment; supplemental pay for health coverage is provided until enrollment is complete.

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.
Ability to obtain a security clearance; applicants must be U.S. citizens.

Nice To Haves

Ability to perform 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 procedure and diagnosis code coding.
Research and resolve system edits, audits, and claim errors using approved references and investigative sources.
Coordinate with internal departments to work edits and deferrals.
Update patient identification, other health insurance, provider identification, and other files as necessary.

Benefits

Subsidized health plans.
Dental coverage.
Vision coverage.
401(k) retirement savings plan with company match.
Life insurance.
Paid time off (PTO).
On-site cafeterias and fitness centers at major locations.
Education assistance.
Service recognition.
National discounts for movies, theaters, zoos, theme parks, and more.
Supplemental pay for health coverage until required health insurance enrollment is complete.