Springfield, Illinois, United States · On-site
$20/hr–$38/hr
Summary Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with …
Skills: Financial Auditing, Compliance Auditing, Operational Auditing, Internal Controls Evaluation, Data Analysis
Columbia, South Carolina, United States · Hybrid
Summary First 60 days this position is onsite. After 60 days, incumbent will have remote Friday's. Ultimately the goal is to reach two days remote. Account management and healthcare experience strongly preferred. Serves …
Skills: Account Management, Client Relationship Management, Healthcare Knowledge, Problem Solving, Written Communication
Florence, South Carolina, United States · On-site
Summary Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. De…
Skills: Customer Service, Claims Processing, Appeals Processing, Verbal Communication, Written Communication
Columbia, South Carolina, United States · On-site
Summary We have a job opening for the position of Accounting/Audit Business Unit Student at Palmetto GBA, a subsidiary of BlueCross BlueShield of South Carolina. Responsibilities may vary based on departmental needs and …
Skills: Oral Communication, Written Communication, Organizational Skills, Attention To Detail, Analytical Thinking
Columbia, South Carolina, United States · On-site
Summary Manages claims and customer service areas. Description Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. This role is located on-site at 17 Technology Circle, Col…
Skills: Claims Processing, Appeals Processing, Customer Service, Staff Management, Process Improvement
Columbia, South Carolina, United States · Hybrid
Summary Supports the Model Audit Rule (MAR/SOX) Department in the compliance effort that results in annual reporting to the Department of Insurance in activities such as, but not limited to: risk assessments, process doc…
Skills: Auditing, Sarbanes-Oxley (SOX), Compliance, Internal Controls, Risk Assessment
Myrtle Beach, South Carolina, United States · Hybrid
Summary Performs medical reviews using established criteria sets and/or performs utilization management of professional, inpatient or outpatient, facility benefits or services, and appeals. Documents decisions using indi…
Skills: Medical Review, Utilization Management, Clinical Guidelines, Medical Claims Review, Customer Service
Columbia, South Carolina, United States · On-site
Summary Responsible for the accurate and timely processing of claims. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) M…
Skills: Claims Processing, Analytical Skills, Organizational Skills, Customer Service, Oral Communication
Columbia, South Carolina, United States · On-site
Summary Responsible for the accurate and timely processing of claims. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) M…
Skills: Analytical Skills, Organizational Skills, Customer Service, Oral Communication, Written Communication
Oklahoma City, Oklahoma, United States · Hybrid
Summary Leads corporate distribution systems, general agents, brokers, and other market support personnel. Responsible for planning, product development, marketing services, production and profitability for as few as two…
Skills: Insurance Sales, Insurance Marketing, Underwriting, Sales Negotiation, Product Development
Springfield, Illinois, United States · On-site
$20/hr–$38/hr
Summary Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with …
Skills: Financial Auditing, Compliance Auditing, Operational Auditing, Internal Controls Evaluation, Data Analysis
Columbia, South Carolina, United States · On-site
Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquires may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed…
Skills: English Fluency, Spanish Fluency, Claims Processing, Customer Service, Verbal Communication
Nashville, Tennessee, United States · Hybrid
Summary Oversees the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identi…
Skills: Medical Review, Utilization Review, Medicare Claims Processing, Staff Management, Process Improvement
Columbia, South Carolina, United States · On-site
Summary Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roo…
Skills: General Ledger Reconciliation, Journal Entries, Financial Reporting, Financial Analysis, Budgeting
Columbia, South Carolina, United States · On-site
Summary Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roo…
Skills: General Ledger Reconciliation, Journal Entries, Financial Reporting, Financial Analysis, Budgeting
Arlington, Texas, United States · Remote OK
$58k–$110k/yr
Summary Rates and designs benefits for largest and most complex groups. Serves as primary contact to stop loss vendors. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Othe…
Skills: Underwriting, Risk Principles, Benefit Design, Stop Loss Management, Analytical Thinking
Columbia, South Carolina, United States · On-site
Summary Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established sta…
Skills: Provider Enrollment, Data Verification, Customer Service, Analytical Thinking, Microsoft Office
Nashville, Tennessee, United States · Remote OK
Summary We are currently hiring for an Appeals Analyst to join BlueCross BlueShield of South Carolina. In this role as Appeals Analyst, you will research the substance of complex appeal or retrospective review requests i…
Skills: Clinical Review, Benefit Analysis, Medical Necessity Guidelines, Utilization Review, Case Management
Sign up with Clera and we'll reach out the moment a role actually fits you — no more spraying applications into the void.
The role involves executing financial, compliance, and operational audits to ensure adherence to organizational policies and internal controls. Responsibilities include interviewing personnel, testing corrective actions, and preparing detailed reports with recommendations for management.
A Bachelor's degree in a job-related field is required, though no previous work experience is necessary. Candidates should possess knowledge of auditing principles and the ability to analyze financial data and communicate findings effectively.
This is a full-time on-site position work at 3021 Montvale Drive Suite D Springfield, Illinois 62704.
Conducts audits of the financial, management, and administrative procedures of assigned divisions, providers, departments, and various lines of businesses throughout the organization to ensure that procedures are in compliance. Audits include interviewing key personnel, conducting testing, evaluating internal controls, analyzing existing financial and management practices to determine effectiveness, and reviewing relevant documentation to support findings.
Develops detailed reports on each audit conducted. Reports include a review of findings and an identification of recommendation to correct any deficiencies and methods for improvement to processes. Conducts testing of corrective actions as identified.
Conducts special audit studies for management, such as those required to discover controls for prevention of fraud. Prepares reports of finding and recommendations for management.
Assists other auditors in completing their assignments as a means of maximizing audit efficiency and thus reducing lost time and involvement of corporate personnel.
Required Education: Bachelor's in a job related field
Required Work Experience: No previous work experience required.
Required Skills and Abilities: Knowledge of the principles and practices of auditing. Ability to analyze and determine the applicability of financial data. Ability to draw conclusions and make appropriate recommendations for analyzed data. Ability to gather information by examining records and documents and interviewing individuals. Strong interpersonal skills and the ability to work professionally with persons at all levels. Ability to communicate clearly and effectively in oral and written form. Ability to handle sensitive matters on a confidential basis.
Required Software and Tools: Microsoft Office.
Preferred Licenses and Certificates: Certified Internal Auditor (CIA) or Certified Public Accountant (CPA) or Certified Information Systems Auditor (CISA)
Work Environment: Typical office environment. Travel between office buildings required. Out of town travel may be required.
Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits at 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
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.
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.
$20.84
$29.59
$38.33
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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency
Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.
If you need special assistance or an accommodation while seeking employment, please email [email protected] or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
Some states have required notifications. Here's more information.
South Carolina’s largest and oldest health insurance company
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now! BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. We are an Equal Opportunity Employer. We will consider all qualified applicants for employment 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.
Offices: I-20 E at Alpine Road, Columbia, South Carolina 29219, US
South Carolina’s largest and oldest health insurance company
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now! BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. We are an Equal Opportunity Employer. We will consider all qualified applicants for employment 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.
Offices: I-20 E at Alpine Road, Columbia, South Carolina 29219, US
