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
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose: 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.
Logistics: CGS (cgsadmin.com) – one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00am-4:00pm CST. This role is located at 26 Century Blvd Suite ST610 Nashville, TN 37214.
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 cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
Sponsorship: This position is not eligible for sponsorship now or in the future.
What You’ll 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.
To Qualify for This Position, You'll Need the Following:
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.
We Prefer That You Have the Following:
Preferred Work Experience: 2 years of claims processing experience.
Preferred Skills and Abilities:
Strong time management skills.
Strong attention to detail skills.
Knowledge of mathematical and statistical concepts.
Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. proficient database software skills.
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…