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Claims Processor II

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BlueCross BlueShield of South Carolina

Oct 12

  • Job
    Full-time
    Junior Level
  • Accounting & Tax
    Healthcare
  • Florence
  • Quick Apply

AI generated summary

  • You need a high school diploma, 2 years of claims processing experience, strong organizational and communication skills, proficiency in Microsoft Office, and ability to handle confidential info discreetly.
  • You will process complex claims, verify coding, correct errors, resolve issues, and respond to correspondence while ensuring adherence to quality standards and internal guidelines.

Requirements

  • Required Education:
  • High School Diploma or equivalent
  • Required Work Experience:
  • Two 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.

Responsibilities

  • 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.

FAQs

What are the primary responsibilities of a Claims Processor II?

The primary responsibilities include examining and processing complex or specialty claims, ensuring accuracy in claims coding, correcting processing errors, researching and resolving claim issues, and assisting in training or mentoring new staff members.

What qualifications are required for this position?

A High School Diploma or equivalent is required, along with two years of experience in processing, researching, and adjudicating claims.

What skills are essential for a Claims Processor II?

Essential skills include strong organizational, analytical, and judgment skills; effective oral and written communication; proficiency in spelling, punctuation, and grammar; basic business math abilities; and the capability to handle confidential or sensitive information with discretion.

What software or tools do I need to be proficient in?

Proficiency in Microsoft Office is required for this position.

Is there a training program for new employees?

Yes, this position includes assisting in training or mentoring new staff members.

Are there opportunities for advancement within the company?

Yes, BlueCross BlueShield of South Carolina values employee growth and may offer opportunities for advancement based on performance and experience.

What does the company do to promote equal employment opportunities?

The company maintains a policy of nondiscrimination in employment and promotes employment opportunities regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, or other legally protected statuses.

How does the company accommodate individuals with disabilities?

The company is committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities on a case-by-case basis.

How can I request reasonable accommodations during the job application process?

You can request reasonable accommodations by emailing mycareer.help@bcbssc.com or calling 1-800-288-2227, ext. 47480 with the nature of your request.

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BlueCross BlueShield of South Carolina

South Carolina’s largest and oldest health insurance company

Finance
Industry
10,001+
Employees
1946
Founded Year

Mission & Purpose

BlueCross BlueShield of South Carolina, the state's largest insurance company, has been a part of the national landscape for over six decades. With an A+ Superior rating from A.M. Best, the company is a leading government contract administrator and operates one of the most advanced data processing centers in the Southeast. BlueCross offers employees robust benefits, including retirement plans, health coverage, and education assistance, while fostering a culture of community support, with employees actively contributing to numerous nonprofit organizations each year.