Specialist, Provider File I-2

BlueCross BlueShield of South Carolina • Florence, SC

1d • Onsite

About The Position

This position is responsible for establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing. BlueCross BlueShield of South Carolina has been part of the national landscape for more than seven decades, with roots firmly embedded in the South Carolina community. The company is the largest insurance company in South Carolina, a leading administrator of government contracts, and operates a sophisticated data processing center in the Southeast. It has a diverse family of subsidiary companies and is dedicated to delivering outstanding service to its customers. The position is full-time (40-hours/week) Monday-Friday in a typical office environment, working an 8-hour shift scheduled during normal business hours of 8:00 AM-5:00 PM. Occasional overtime may be necessary, and travel between buildings may be required. This role is located onsite at 160 North Dozier Boulevard Florence, SC 29501. The position requires the ability to obtain a security clearance, necessitating applicants to be U.S. Citizens. As a Service Contract Act (SCA) employee, enrollment in the company's health insurance is required, with supplemental pay for health coverage provided until enrollment is complete. Coverage begins on the first day of the month following 28 days of full-time employment. The company values a diverse and inclusive workplace, striving to be an employer where employees can develop skills, advance careers, and contribute their unique abilities. BlueCross BlueShield of South Carolina holds an A.M. Best rating of A+ (Superior) and is a strong supporter of veterans, offering pay differential coverage for full-time employees in the National Guard or Reserves called to active duty.

Requirements

• High School Diploma or equivalent
• 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.
• Working knowledge of word processing and spreadsheet software.
• Knowledge/understanding of or ability to acquire PIMS.
• Good judgment skills.
• Effective customer service and organizational skills.
• Demonstrated verbal and written communication skills.
• Basic business math proficiency.
• Ability to handle confidential or sensitive information with discretion.
• Microsoft Office.
• Ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Nice To Haves

• Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes.
• Excellent telephone skills and previous Customer Service experience.

Responsibilities

• Verifies necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or establishes certification of healthcare service providers.
• Prepares provider files/maintains provider data (updates, additions, deletions) on the provider information management system (PIMS) or appropriate provider system/database.
• Identifies/assigns providers to the appropriate network and provider system/database.
• Contributes to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.
• Contributes to and participates on special projects, which may include but are not limited to the following: mass rate updates, quality improvement, audits, etc.

Benefits

• Subsidized health plans, dental and vision coverage
• 401k 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
• Coverage for the difference in pay for full-time employees in the National Guard or Reserves called to active duty.

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees