Claims Processor I

About the role

Responsible for the accurate and timely processing of claims. PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies. This position is full-time (40‑hours/week) Monday‑Friday from 8am‑5pm in a typical office environment, located on‑site at 17 Technology Cir, Columbia, SC 29203. The role requires the ability to obtain a security clearance (U.S. Citizenship required). Under the Service Contract Act (SCA), employees must enroll in the company health insurance even if they have other coverage; supplemental pay for health insurance is provided until enrollment, effective the first of the month following 28 days after hire.

Responsibilities

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

Qualifications

• High School Diploma or equivalent.