Job description
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 position is a full-time work at home position(40 hours/week) Monday-Friday. Depending on availability on equipment for W@H use you will work at the onsite building located at 4101 Percival Road, Columbia S.C., 29219 until equipment is available.
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.
Required Education:
High School Diploma or equivalent
Required Work Experience:
2 years of experience processing, researching and adjudicating claims.
Required Skills and Abilities:
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.
Required Software and Tools:
Microsoft Office.
Preferred Work Experience: 5 years-of experience processing and adjudicating claims.
Preferred Skills and Abilities:
Strong time management skills. Knowledge of mathematical and statistical concepts.
Preferred Software and Other Tools:
Proficient in word processing and spreadsheet applications. proficient database software skills.
Work Environment:
Typical office environment.
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
- Onsite cafeterias and fitness centers in significant locations
- Wellness programs and a healthy lifestyle premium discount
- Tuition assistance
- Service Recognition
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 skills, advance their careers and contribute their unique abilities to the growth of our company.
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 conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
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.
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