Processor, Claims II

BlueCross BlueShield of South Carolina•Nashville, TN

5d•Onsite

About The Position

The Processor, Claims II reviews and adjudicates complex or specialty claims, determining whether to return, deny, or pay them in accordance with organizational policies, procedures, business and contract regulations, internal standards, and examining guidelines. The role also assists with training or mentoring new staff members. This is a full-time, 40-hour-per-week position with CGS, a BlueCross BlueShield of South Carolina subsidiary. The schedule is Monday through Friday, with an 8-hour shift scheduled during normal business hours of 8:00 a.m. to 4:00 p.m. CST. The position is located in a typical office environment at 26 Century Blvd, Suite ST610, Nashville, TN 37214. The position requires a high school diploma or equivalent and two years of experience processing, researching, and adjudicating claims. Employees are subject to Service Contract Act benefit requirements and cannot opt out of health benefits. Supplemental pay is provided until enrollment in health benefits, which begins 28 days after hire. This position is not eligible for sponsorship.

Requirements

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

Nice To Haves

Two years of claims processing experience.
Strong time management skills.
Strong attention to detail.
Knowledge of mathematical and statistical concepts.
Proficiency in word processing and spreadsheet applications.
Proficient database software skills.

Responsibilities

Examine and process complex or specialty claims according to business and contract regulations, internal standards, and examining guidelines.
Enter claims into the claim system after verifying correct procedure and diagnosis coding.
Verify that claims have been keyed correctly.
Ensure claims are processed according to established quality and production standards.
Correct processing errors by reprocessing, adjusting, and/or recouping claims.
Research and resolve claims edits and deferrals.
Research claim problems using policies, procedures, reference materials, and forms, and coordinate with internal support areas.
Respond to routine correspondence and complete spreadsheets when applicable.
Assist in training or mentoring new staff members.