Processor, Claims I

PGBA•Myrtle Beach, SC

1d•Onsite

About The Position

Responsible for the accurate and timely processing of claims. 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. Coordinates with internal departments to work edits and deferrals, updating patient identification, other health insurance, provider identification, and other files as necessary. This full-time position is with PGBA, a BlueCross BlueShield of South Carolina subsidiary company. It is on-site at 8733 Highway 17 Bypass, Myrtle Beach, South Carolina, in a typical office environment, Monday through Friday, 8:00 a.m. to 5:00 p.m. 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 a Service Contract Act employee, the employee is required to enroll in the company’s health insurance, even if covered by another plan. 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.
Enroll in the company’s health insurance as a Service Contract Act 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 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 in major locations
Education assistance
Service recognition
National discounts to movies, theaters, zoos, theme parks, and more
Supplemental pay for health coverage until required health insurance enrollment is complete