Processor, Claims II

CGS Administrators, LLC • Nashville, TN

6d • Onsite

About The Position

Reviews and adjudicates complex or specialty claims, determining whether claims should be returned, denied, or paid in accordance with organizational policies and procedures. The role also assists in training or mentoring new staff members.

The position processes claims according to applicable business and contract regulations, internal standards, and examining guidelines. It verifies procedure and diagnosis coding, enters claims into the claim system, and checks that claims were keyed correctly. The Processor, Claims II monitors quality and production standards, corrects processing errors, researches claim edits and deferrals, and resolves claim issues using policies, procedures, reference materials, and coordination with internal support areas. The role also responds to routine correspondence and completes spreadsheets when applicable.

This is a full-time, 40-hour-per-week position, Monday through Friday, in a typical office environment. The scheduled eight-hour shift falls within normal business hours of 8:00 a.m. to 4:00 p.m. CST. The work location is 26 Century Blvd, Suite ST610, Nashville, TN 37214. The position is with CGS, a BlueCross BlueShield of South Carolina subsidiary. It is not eligible for sponsorship now or in the future. Employees covered by the Service Contract Act cannot opt out of health benefits; supplemental pay is provided until enrollment in health benefits 28 days after the hire date.

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.
• Verify correct procedure and diagnosis coding, enter claims into the claim system, and 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.
• Investigate 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.

Benefits

• Subsidized health plans, dental and 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 until enrollment in health benefits 28 days after the hire date, as applicable under the Service Contract Act.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED