Processor, Claims I

PGBA,•Myrtle Beach, SC

2d•Onsite

About The Position

The Processor, Claims I is 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 coding; resolves system edits, audits, and claims errors using approved references and investigative sources; and coordinates with internal departments to work edits and deferrals and update patient identification, other health insurance, provider identification, and other files. This is a full-time, 40-hour-per-week, on-site position with PGBA, a BlueCross BlueShield of South Carolina subsidiary. The schedule is Monday through Friday, 8:00 a.m. to 5:00 p.m., in a typical office environment at 8733 Highway 17 Bypass, Myrtle Beach, South Carolina. The position requires the ability to obtain a security clearance; applicants must be U.S. citizens. The role is not eligible for sponsorship now or in the future. As an employee covered by the Service Contract Act, the employee must enroll in the company's health insurance, even if they have other health coverage. 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.
Must enroll in the company's health insurance 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.
Resolve system edits, audits, and claims errors through research and use of 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.