Summary Responsible for the maintenance of records and the processing of claims in medical review along with any and/or all of the following: processes ingoing/outgoing mail and prepares work for nursing staff. Troubleshoots claims prior to nurse review and after review. Monitors timeliness of claims processing and adjusts claims keyed incorrectly. Performs quality control of work processes. Description Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. This is not an IT or computer science role. It's a detail-oriented, clerical support position serving the medical review team. If you have strong administrative skills and an interest in healthcare operations, this role is a great fit. This position is full time (40 hours/week) Monday-Friday 8:00-4:30 and will be onsite at your closer location: Palmetto GBA 160 Dozier BLVD, Florence, S.C. 29501 Palmetto GBA 17 technology circle Columbia, SC 29203 Palmetto GBA 2743 Perimeter Pkwy, Augusta, GA 30909-6429 SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. What You Will Do: You'll be the clerical backbone of Palmetto GBA's medical review team — making sure nurses have complete, accurate information to make clinical decisions. This is computer-based work; phone contact is minimal and limited to returned-mail situations only. Processes denials of claims. Processes adjustment claims for both pre-pay and post-pay departments. Investigates and analyzes adjustment claim history and denial records. Prescreens records for review and maintains accurate records of all claims. Communicates with provider community and assists provider service department in responding to inquiries. Generates educational correspondence to providers regarding denials. Performs quality control of work processes. Assists manager with special projects. To Qualify for This Position, You Will Need: Associate's Degree Equivalency: 2 years job related work experience Required Work Experience: 1 year administrative/clerical support. Required Skills and Abilities: Working knowledge of word processing software. Strong analytical, organizational, and customer service skills. Strong verbal and written communication skills. Proficiency in spelling, punctuation, and grammar skills. Good judgment skills. Ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office. What We Prefer: FISS Experience Medicare experience Claims knowledge What We Can Do for You: 401(k) retirement savings plan with company match. Subsidized health plans and free vision coverage. Life insurance. Paid annual leave – the longer you work here, the more you earn. Nine paid holidays. On-site cafeterias and fitness centers in major locations. Wellness programs and healthy lifestyle premium discount. Tuition assistance. Service recognition. Incentive Plan. Merit Plan. Continuing education funds for additional certifications and certification renewal 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 mycareer.help@bcbssc.com 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. If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to Join Our Talent Community by submitting your resume and contact information and we will reach out if we find a good fit. Palmetto GBA is a healthcare service administrator and one of the nation’s largest providers of high-volume medical claims and transaction processing. We provide services and technology solutions to improve and streamline healthcare administration not only for government but also for corporate entities. We offer a wide range of services that require a diverse workforce and expansive areas of expertise from data analytics, administrative and workflow services to advanced systems. To help our associates succeed and reach their professional goal, we offer training classes and programs that help employees prepare for leadership positions and offer tuition assistance for education advancement. Palmetto GBA acknowledges associates’ hard work and dedication with awards and financial incentives.