Claims Processor II

Internal Reference Number: R1048695

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.

CGS () – one of Blue Cross Blue Shield’s South Carolina subsidiary companies. Position is full‑time (40‑hours/week) Monday‑Friday from 8:00 am–4:30 pm and will be fully remote.

• 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 spreadsheets if applicable.

• 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.

• 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, and proficient database software skills.

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

• 401(k) 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