full-timeNashville$0k - $0k

Summary

Location

Nashville

Salary

$0k - $0k

Type

full-time

Explore Jobs

About this role


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
 

Logistics: CGS (cgsadmin.com) 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.

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.

  • 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 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

What We Can Do for You:

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.

What To Expect Next:

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.

Pay Range Information:

Range Minimum 

$ 13.21

Range Midpoint 

$ 17.38 

Range Maximum 

$ 24.33

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

Other facts

Tech stack
Claims Processing,Researching,Adjudicating Claims,Organizational Skills,Analytical Skills,Judgment Skills,Communication Skills,Business Math,Confidentiality,Microsoft Office,Time Management,Statistical Concepts,Word Processing,Spreadsheet Applications,Database Software Skills

About BlueCross BlueShield of South Carolina

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.

Team size: 10,001+ employees
LinkedIn: Visit
Industry: Insurance
Founding Year: 1946

What you'll do

  • The Claims Processor II reviews and adjudicates complex claims, determining whether to return, deny, or pay them according to policies. They also assist in training new staff and ensure claims are processed according to quality standards.

Ready to join BlueCross BlueShield of South Carolina?

Take the next step in your career journey

Frequently Asked Questions

What does BlueCross BlueShield of South Carolina pay for a Claims Processor II-2?

BlueCross BlueShield of South Carolina offers a competitive compensation package for the Claims Processor II-2 role. The salary range is USD 0k - 0k per year. Apply through Clera to learn more about the full compensation details.

What does a Claims Processor II-2 do at BlueCross BlueShield of South Carolina?

As a Claims Processor II-2 at BlueCross BlueShield of South Carolina, you will: the Claims Processor II reviews and adjudicates complex claims, determining whether to return, deny, or pay them according to policies. They also assist in training new staff and ensure claims are processed according to quality standards..

Why join BlueCross BlueShield of South Carolina as a Claims Processor II-2?

BlueCross BlueShield of South Carolina is a leading Insurance company. The Claims Processor II-2 role offers competitive compensation.

Is the Claims Processor II-2 position at BlueCross BlueShield of South Carolina remote?

The Claims Processor II-2 position at BlueCross BlueShield of South Carolina is based in Nashville, Tennessee, United States. Contact the company through Clera for specific work arrangement details.

How do I apply for the Claims Processor II-2 position at BlueCross BlueShield of South Carolina?

You can apply for the Claims Processor II-2 position at BlueCross BlueShield of South Carolina directly through Clera. Click the "Apply Now" button above to start your application. Clera's AI-powered platform will help match your profile with this opportunity and guide you through the application process. You can also learn more about BlueCross BlueShield of South Carolina on their website.