Claims Processor - PGBA-

Position: Claims Processor I - PGBA-27
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* Location:

** This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. It may be necessary, given the business need to work occasional overtime. The role is located on-site at 200 N Dozier Blvd., Florence, SC 29501.
** Government Clearance:
** This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
** SCA Benefit Requirements:
** Blue Cross Blue Shield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act *(
* SCA*).
* ** 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.*
* * Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes.
* Resolves system edits, audits and claims errors through research and use of approved references and investigative sources.
* Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary.
* ** Required

Skills and Abilities:

*** 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.
* ** Required Software and Tools:
** Basic office equipment.
** Required

Education:

** High School Diploma or equivalent
** Preferred

Work Experience:

** 1 year-of experience in a healthcare or insurance environment.
** Preferred

Skills and Abilities:

** Ability to use complex mathematical calculations.
* 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

PGBA, LLC is a leading provider of administrative services for the TRICARE health benefit program and health benefit programs of Veteran’s Health Administration for both state and federal governments. The company has offices in Florence, Surfside Beach, and Columbia, South Carolina.

PGBA employees work in an atmosphere that is conducive to growth and on that fosters a focus on personal and professional development with an environment made up of people from different parts of the world with diverse cultural Excellent benefits, as well as a competitive compensation program, make us one of the leading employers in today’s corporate market.
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