As a Claims Processor II you will review and adjudicate complex or specialty claims.  You will determine whether to return, deny, or pay claims following organizational policies and procedures.  You will assist in training or mentoring new staff members.  You will also complete internal reporting as directed.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Logistics:

This is a Work at Home (W@H) position. The hours are 7:00 a.m. – 4:00 p.m. Central Standard Time (CST) Monday – Friday.

What You’ll Do:

• Examine and process complex or specialty claims according to business / contract regulations, internal standards, and examining guidelines.
• Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Verify that claims have been keyed correctly.
• Ensure that claims are processing according to established quality and production standards.
• Correct processing errors by reprocessing, adjusting, and / or recouping claims.
• Research and resolve claim edits and deferrals.
• Perform research on claim problems by utilizing policies, procedures, reference materials, forms, and coordinates with various internal support areas.
• Respond to routine correspondence and completes spreadsheet if applicable.

To Qualify for This Position, You’ll Need:

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

What We Prefer:

• Five years-of experience processing and adjudicating claims.
• Part B Medicare claims processing with use of MCS system.
• Strong time management skills.
• Knowledge of mathematical and statistical concepts.
• Proficient in word processing and spreadsheet applications.
• Proficient database software skills.

What We can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized 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 healthy lifestyle premium discount.