Processor, Claims II (Medicare Part B Professional Claims)

Palmetto GBA•Florence, SC

1d•Onsite

About The Position

This position involves reviewing and adjudicating complex or specialty claims, determining whether to return, deny, or pay claims in accordance with organizational policies and procedures. BlueCross BlueShield of South Carolina, a company with over seven decades of history, is the largest insurance company in South Carolina and a leading administrator of government contracts. The company operates a sophisticated data processing center and has a diverse family of subsidiary companies. This role is with Palmetto GBA, one of BlueCross BlueShield of South Carolina's subsidiary companies, which is a healthcare service administrator and a large provider of medical claims and transaction processing.

Requirements

High School Diploma or equivalent
2 years of experience processing, researching and adjudicating claims
Strong organizational, analytical and judgment skills
Strong oral and written communication skills
Proficient in spelling, punctuation and grammar
Proficient in basic business math
Ability to handle confidential or sensitive information with discretion
Microsoft Office

Nice To Haves

5 years-of experience processing and adjudicating claims
Strong time management skills
Knowledge of mathematical and statistical concepts
Proficient in word processing and spreadsheet applications
proficient database software skills

Responsibilities

Examines and processes complex or specialty claims according to business/contract regulations, internal standards and examining guidelines.
Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
Verifies that claims have been keyed correctly.
Ensures that claims are processing according to established quality and production standards.
Corrects processing errors by reprocessing, adjusting, and/or recouping claims.
Researches and resolves claims edits and deferrals.
Performs research on claim problems by utilizing policies, procedures, reference materials, forms and coordinates with various internal support areas.
Responds to routine correspondence and completes spreadsheet if applicable.