Summary
 

Responsible for the accurate and timely processing of claims.

Description
 

Logistics:

PGBA – is a subsidiary company of BlueCross BlueShield of South Carolina.

Location:

This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility work any our 8-hour shift scheduled during hours of 8:00 AM –5:00 PM. Training will be Monday – Friday 8:00 AM - 4:30/5:00 PM for approximately 6-8 weeks. This role is located on site at 8733 Highway 17 Bypass, Myrtle Beach, SC 29575.

• Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
• SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees are required to enroll in health insurance benefits regardless of other insurance coverage. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

What You’ll Do:

• Research and process claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes.
• Resolves system edits, audits and claims errors through research and use of approved references and investigative sources.
• Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.

To Qualify for This Position, You’ll Need the Following:

• Required Education:
• High School Diploma or equivalent
• Required Skills and Abilities:
• Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math skills.
• Required Software and Tools:
• Basic office equipment.

We Prefer You Have the Following:

• 1 year of experience in a healthcare of insurance environment.
• Ability to use complex mathematical calculations.
• Proficient in word processing and spreadsheet applications.
• Proficient in database software.

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits for the first of the month following 28 days of employment.  

• 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
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Employee Assistance
• Discounts to movies, theaters, zoos, theme parks and more

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 the opportunity to develop their