[Hiring] Claims Processor II @001 BlueCross and BlueShield of South Carolina

This description is a summary of our understanding of the job description. Click on 'Apply' button to find out more. Role Description We are currently hiring for a Claims Processor II to join BlueCross BlueShield of South Carolina. In this role as Claims Processor II, you will be responsible for reviewing and adjudicating complex or specialty claims. You will determine whether to return, deny or pay claims following organizational policies and procedures. You will also assist in training or mentoring new staff members. Logistics: Planned Administrators Inc. (PAI)– one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am-4:30pm and will be fully remote. The candidate may be asked to come on-site for training, meetings, or other business needs. Candidates must reside within a one-hour commute of the Columbia location. 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. Qualifications • 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 proficiency. Requirements • 2 years of claims processing experience preferred. • Strong time management skills preferred. • Knowledge of mathematical and statistical concepts preferred. • Proficient in word processing and spreadsheet applications preferred. • Proficient database software skills preferred. Benefits • 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 • Education Assistance • Service Recognition • National discounts to movies, theaters, zoos, theme parks and more