Processor, Claims II

BlueCross BlueShield of South Carolina•Nashville, TN

2d•Onsite

About The Position

CGS, a BlueCross BlueShield of South Carolina subsidiary, is hiring a Processor, Claims II to review and adjudicate complex or specialty claims. The role determines whether claims should be returned, denied, or paid in accordance with organizational policies and procedures, and assists in training or mentoring new staff members. 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 position is located at 26 Century Blvd, Suite ST610, Nashville, TN 37214. Because the company and its subsidiaries have federal government contracts subject to the Service Contract Act, employees cannot opt out of health benefits. Employees receive supplemental pay until enrolled in health benefits 28 days after their hire date. This position is not eligible for current or future 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.
Proficiency in database software.

Responsibilities

Examine and process complex or specialty claims in accordance with 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.

Benefits

Subsidized health plans, with benefits eligibility beginning the first of the month following 28 days of employment.
Dental coverage.
Vision coverage.
401(k) retirement savings plan with company match.
Life insurance.
Paid time off (PTO).
On-site cafeterias and fitness centers at major locations.
Education assistance.
Service recognition.
National discounts to movies, theaters, zoos, theme parks, and more.
Supplemental pay until enrolled in health benefits 28 days after the hire date.