• Job Description

  Req#: R1029439

  
  Summary
  

  Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.

  
  Description
  

  Logistics:

  • This will be a remote (work from home position) after eight weeks of onsite training in our Percival Road, Columbia, SC office.
  • Must have high-speed internet (non-satellite) and a private space in your home for an office.
  • Work hours: 8:00 am to 4:30 pm Monday through Friday.

  What You Will Do:

  • 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.

  What You Need to Qualify:

  • High School Diploma or equivalent
  • 2 years of experience processing, researching and adjudicating claims.
  • Microsoft Office.

  What We Prefer You Have:

  • ITS/Blue2 experience.
  • Working knowledge of Excel.

  What We Can Do for You:

  We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

  Our comprehensive benefits package includes:

  • 401(k) retirement savings plan with company match
  • Fantastic health plans and free vision coverage
  • Life insurance
  • Paid annual leave — the longer you work here, the more you earn
  • Nine paid holidays
  • On-site cafeterias and fitness centers in major locations
  • Wellness programs and a healthy lifestyle premium discount
  • Tuition assistance
  • Service recognition

  What to Expect Next:

  After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with the most qualified candidates.

  
  
  

  We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

  Equal Employment Opportunity Statement

  BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

  We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

  If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

• About the company

  When you hear "BlueCross BlueShield of South Carolina," you'll see people nodding in recognition. Most everyone knows who we are. As the only South Carolina-owned and operated health insurance carrier, we have been offering security to Palmetto State citizens for more than 70 years. We are also one of South Carolina's largest employers.

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