Processor, Claims I

PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies. This position is full-time (40-hours/week) Monday-Friday from 8:00am-5:00pm in a typical office environment, located on-site at 8733 Highway 17 Bypass, Myrtle Beach, South Carolina. This role requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. This position is not eligible for sponsorship now or in the future.

About the role

To comply with the McNamara-O'Hara Service Contract Act (SCA), employees must enroll in our health insurance even if they have other health insurance. Employees will receive supplemental pay for health insurance until they are enrolled in our health insurance, first of the month following 28 days after the hire date.

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 the patient identification, other health insurance, provider identification, and other files as necessary.

Requirements

• High School Diploma or equivalent.
• 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.
• Basic office equipment proficiency.

Qualifications

We prefer that you have the following:

• 1 year of claims processing experience.
• Ability to use complex mathematical calculations.
• Proficiency in word processing and spreadsheet applications.
• Proficiency in database software.

Benefits

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.
• Education Assistance.
• Service Recognition.
• National discounts to movies, theaters, zoos, theme parks, and more.