Processor, Claims II

Location: Columbia

## Processor, Claims IIApply:
On-site:
Columbia, South Carolina:
Full time:
Posted Today:
End Date:
September 21, 2026 (4 days left to apply):
R1052009#
** 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
* * Why should you join the Blue Cross Blue Shield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts.

We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
** Position

Purpose:

** 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.
** Logistics:
** PGBA**–
** one of Blue Cross Blue Shield's South Carolina subsidiary companies.
*
* Location:

** This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. This role is located at 17 Technology Cir, Columbia, SC, 29203.
* ** 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).
** As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance.
** Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.
* ** Sponsorship:
** This position is not eligible for sponsorship now or in the future.
*
* 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…