IT/Technology

Summary Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Responsible for directing and managing accounting functions, which may include monthly financial statements, reporting, cost and budgeting, system testing, disbursements, cost allocation, accuracy and integrity of the general ledger, accounts payable and billing, as well as the quarterly and annual compliance areas. Provide assistance on multiple accounting initiatives, including regulatory compliance, annual/quarterly reporting, and other ad-hoc projects. Compiles financial information, consolidates and reports financial data monthly, quarterly and annually based on corporate policy and internal and external requirements. Logistics: BlueCross BlueShield of South Carolina-Companion Life. Location: This is a full-time position working (40-hours/week) Monday-Friday 8:00am – 5:00pm working on-site at 1301 Gervais St Columbia SC, in an office environment. What You’ll Do: •Manage the financial statement close-out process and assist with the issuance of monthly, quarterly, and yearly reports to management or external customers as required. Responsible for the month-end closing by setting the monthly-close calendar; reviewing for accuracy the financial statements: balance sheet, income statement, cash flows statement, refunds, etc.; enforcement of corporate accounting policies; and ensuring timely communication to management and external customers as required. •Collaborates with other management or business areas to address projects, develop policies, procedures and controls, and align resources to meet department needs. Addresses issues or processes impacting the bank accounts and general ledger and provides guidance on treatment of transactions. •Respond to requests from internal and external auditors. Respond and coordinates audit review processes, including the preparation of financial statements and applicable supporting audit/review schedules. •Supervise the preparation and review of all financial functions to ensure all financial deadlines are met. Assist in development and implementation of new procedures and features to enhance the workflow of the department. •Supervise and coordinate the daily activity of the staff. Responsible for training and various personnel functions including, but not limited to hiring, and conducting performance evaluations. To Qualify for This Position, You’ll Need The Following: •Bachelor's degree in Accounting or related degree with 24 semester hours of accounting. (Anyone hired prior to August 1, 2008 in an accounting position only requires 21 semester hours of accounting.) •8 years of accounting experience including 2 years in a supervisory role OR 1 year of supervisory experience and 3 years of experience in a lead role OR 2 years of equivalent military experience in grade E4 of above. •Excellent communication skills. In-depth knowledge of accounting principles and practices. •Excellent analytical and problem-solving skills. •Strong project management, organizational, decision-making, and flexibility skills. •Highly effective leadership skills. •Proficient business math skills. Excellent professional written and verbal communication skills. •Strong knowledge of fundamental accounting concepts, practices and procedures. •Knowledge of mathematical and statistical concepts. •Able to persuade, influence or negotiate with others. •Ability to handle confidential or sensitive information with discretion. •Proficiency with Microsoft Office in order to create charts, graphs, and spreadsheets for business analysis. We Prefer You To Have The Following: •Bachelor's degree in Accounting. •Computer systems and business objects knowledge. •Statutory reporting experience •Certified Public Accountant (CPA), Charted Financial Analyst (CFA) or Certified Treasury Professional (CTP) or Certified Management Accountant (CMA). Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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. What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 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 .

Summary Acts as a Team Lead by providing guidance/direction/training to Provider Enrollment Analysts and/or other Provider Enrollment area staff. Responsible for the processing of difficult enrollment applications and/or complex inquiries. Description Logistics: Palmetto GBA – one of BlueCross BlueShield'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. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 17 Technology Circle, Columbia, SC, 29203 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). 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. What You'll Do: Functions as Team Leader/senior-level Enrollment Analyst. Provides leadership/guidance/direction/training to staff. Distributes work and is available to answer questions from staff. Acts as a resource for staff regarding any escalating issues. Keeps manager informed of any problems/issues that need resolving. Conducts quality reviews of completed work. Ensures that all audits are completed, verified, and closed. Performs analysis of audits to determine areas for training, development, and education. Ensures that quality work instructions/forms/documents are developed/revised as needed. Provides quality service and communicates effectively with external/internal customers in response to inquiries (correspondence, telephone). Obtains information from internal departments, providers, government and/or private agencies, etc. to resolve discrepancies/problems. Interprets various guidelines and provides input to required procedures. Generates and analyzes various provider reports to management. Participates in testing system changes related to provider files. Contributes/participates/completes special projects as assigned. To Qualify for This Position, You'll Need the Following: Required Education: Bachelor’s degree equivalency: 4 years job-related work experience or associate's and 2 years job related work experience. Required Work Experience: 2 years of provider network enrollment/certification experience. Required Skills and Abilities: Working knowledge of word processing, spreadsheet, and database software. Working knowledge of provider certification process and claims processing operations/systems. Good judgment skills required. Effective customer service, organizational, and presentation skills required. Demonstrated verbal and written communication skills. Demonstrated proficiency in spelling, punctuation, and grammar skills. Basic business math proficiency required. Analytical or critical thinking skills required. Ability to handle confidential or sensitive information with discretion. In-depth knowledge of pricing methodology and discount programs. In-depth knowledge of Medicare program instructions/regulations related to provider enrollment/issues. Required Software and Tools: Microsoft Office. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 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 .

Summary Performs routine, but varied clerical duties in accordance with standard procedures. This includes clerical duties such as photocopying, compiling records, filing, tabulating, posting information, and distributing mail. Applies knowledge of department policies and procedures, and utilizes a general understanding of other departments' functions. Maintains records, prepares forms, verifies information and resolves routine problems. Description 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. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 8901 Farrow Road Columbia, SC 29203. What You’ll Do: Sorts and distributes incoming departmental mail or work requests. Checks workflow documents to ensure required information is available. Requests any missing documentation as needed. Scans, images and indexes documents. Prepares correspondence or packages for internal/external mailing. Maintains departmental logs, spreadsheets or databases. Keeps track of supply inventory and/or orders supplies as needed. Assists other staff members in related duties as needed. To Qualify For This Position, You'll Need The Following: Required Education: High School Diploma or equivalent Required Experience: No previous work experience required. Required Software and tools: Standard office equipment. Required Skills and Abilities: Good communication and organizational skills. We Prefer That You Have The Following: Office Experience Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 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 .

Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description Logistics This position is full time (40 hours/week) Monday-Friday from 8:00am-6:00pm EST and will be on-site at our Government Programs Complex in Columbia, SC. What You Will Do: Ensures effective customer relations by responding accurately, timely and courteously to telephone, written, web, or walk-in inquiries. Accurately documents inquiries. Initiates or processes adjustments or performs other research as needed to resolve inquiries. Coordinates with other departments to resolve problems. Responds to, researches and/or assists with priority inquiries and special projects as required by management. Provides feedback to management regarding customer problems, questions and needs. Maintains accurate records on complaints and/or other customer comments and makes recommendations for changes to management. Follows through on complaints until resolved or reports to management as needed. Maintains basic knowledge of quality work instructions and company policies. Assists with process improvements through the recommendation of changes in procedures and techniques discovered during daily operations. Maintains all departmental productivity, quality, and timeliness standards. Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments. To Qualify for This Position, You Will Need: High School Diploma or equivalent Excellent verbal and written communication skills. Strong human relations and organizational skills. Ability to handle high stress situations. Good judgment skills. Strong customer service skills. Ability to learn and operate multiple computer systems effectively and efficiently. Basic computer operating skills. Basic use of standard office equipment. What We Prefer: Associate Degree 2 years of customer service or call center experience. Knowledge of word processing, spreadsheet, and database software. 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. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications. 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 .

Summary Performs varied clerical duties in accordance with standard procedures. This includes clerical duties such as photocopying, compiling records, filing, tabulating, posting information, and distributing mail. Applies knowledge of department policies and procedures, and utilizes a general understanding of other departments' functions to resolve most issues. Maintains records, prepares forms, verifies information and resolves routine problems. May assist in orienting and training others Work Environment: The work hours are Monday-Friday 8AM–5PM. Location: 4101 Percival Road Columbia, SC 29229-8320 Description Scan, images and indexes documents. Verify accuracy of data and corrects errors discovered during review or research of documents. Compare or research incoming mail or work requests to ensure related components are put together appropriately and free of errors and duplicates. Sort and distribute documentation appropriately. Prepare correspondence or packages for internal/external mailing. Track correspondence and/or packages and follows up as needed. Maintain departmental logs, spreadsheets or databases. May prepare basic reports/statistics for management on work received for production and workload assessment. Order supplies and maintains departmental supply inventory. Assist other staff members in related duties as needed. To Qualify for This Position, You'll Need: Required Education: High School Diploma or equivalent Required Work Experience: 2 years of clerical or office support experience Required Software and tools: Microsoft Office. Required Skills and Abilities: Good communication and organizational skills. Detail-oriented. Basic business math, computer skills Our comprehensive benefits package includes the following: 401(k) retirement savings plan with company match Fantastic health plans and free vision coverage Life insurance What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications 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 .

Summary Provides education to medical providers as warranted. Description Logistics: Palmetto GBA , – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time Remote (40-hours/week) Monday-Friday in South Carolina. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. There will be some travel involved for in-person conferences and presentations. It may be necessary, given the business need to work occasional overtime. This role is 100% remote in South Carolina only. What You’ll Do: Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts. Documents all provider contacts/communications in provider tracking system. Conducts formal conference calls and/or in-person educational visits with providers that are consistently over utilizing services, on progressive corrective action, or have unacceptable denial rates and/or error rates under the medical review program. Conducts coverage and documentation workshops for provider staff (Medicare providers and physicians' staff). Researches, composes, and coordinates the preparation of all regulatory based provider education materials. Performs analysis of effective reports to determine actions to be taken regarding medical reviewed its/audits. Determines what providers are over-utilizing services and what services are being over-utilized. Works with medical review department and provides input regarding actions taken in response to provider billing practices. Targets providers where greatest abuse of Medicare program has occurred. Participates in the medical review process and inter reviewer reliability (IRR) studies. Assists in training of medical review associates regarding coverage and medical review process. To Qualify for This Position, You'll Need the Following: Required Education: If LPN, graduate of accredited School of Licensed Practical Nursing; if LVN, graduate of accredited School of Licensed Vocational Nursing; if RN, graduate of approved School of Nursing Required Experience: If LPN or LVN, 7 years of clinical experience or equivalent combination of clinical and educator experience. - If RN, 5 years of clinical experience or equivalent combination of clinical and educator experience. Required Software and tools: Microsoft Office. Required Skills and Abilities: Knowledge of medical terminology and disease processes. Demonstrated proficiency in word processing and spreadsheet software. Good judgment skills. Effective customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar. Analytical or critical thinking skills. Basic business math proficiency. Knowledge of mathematical or statistical concepts. Ability to persuade, negotiate, or influence Required Licenses and Certificates: Active LPN or LVN licensure in state hired, OR , active compact multistate LPN license as defined by the Nurse Licensure Compact (NLC), OR active RN licensure in state hired OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) others. Ability to handle confidential or sensitive information with discretion. We Prefer That You Have the Following: Preferred Work Experience : 3 years of provider relations and Medicare experience. Preferred Skills and Abilities: Knowledge of claims processing software. In-depth knowledge of Medicare program, guidelines, regulations governing coverage. Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 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 .

Summary Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description 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 7:30AM-4:00PM. It may be necessary, given the business need to work occasional overtime. This role is located at 4101 Percival Road, Columbia, SC 29229. What You’ll Do: Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines. Examines and processes claims and/or non-medical appeals 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. Ensures claims are processing according to established quality and production standards. Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations. To Qualify for This Position, You'll Need the Following: Required Education: High School Diploma or equivalent. Required Work Experience: 2 years of customer service experience including 1-year claims or appeals processing OR Bachelor's Degree in lieu of work experience. Required Software and Tools: Working knowledge of Microsoft Office. Required Skills and Abilities: Good verbal and written communication skills. Strong customer service skills. Good spelling, punctuation and grammar skills. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 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 .

Summary Functions as work leader for customer service units. Assists with escalated and complex issues. Description 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 7:30AM-5:00PM. It may be necessary, given the business need to work occasional overtime. This role is located at 4101 Percival Road, Columbia, SC 29229. What You’ll Do: Serves as an information source for both internal and external customers by answering complex customer service inquiries via telephone, e-mail, and/or web inquiries. Inquiries are non-routine and require deviation from standard screens, scripts, and procedures. Ensures efficient departmental operation by assisting management in planning, coordination, and/or assignment of work. Assists with the development and direction of staff to achieve and maintain optimum levels of performance. Maintains basic knowledge of quality work instructions and company policies. To Qualify for This Position, You'll Need the Following: Required Education: Associate's degree. Degree Equivalency: 2-years job related work experience. Required Work Experience: 1-year of customer service or claims processing experience OR Bachelor's Degree in lieu of work experience. Required Software and Tools: Advanced knowledge of Microsoft Office. Required Skills and Abilities: Strong organizational skills, and oral and written communication skills. Ability to handle high stress situations. Proficient spelling, punctuation, grammar, and basic business math. Ability to handle confidential or sensitive information with discretion. Ability to learn and operate multiple computer systems effectively and efficiently We Prefer That You Have the Following: Preferred Work Experience: 2-years customer service or claims processing experience. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 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 .

Summary Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, 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 that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Monitor and/or reconcile assigned general ledger accounts of a complex nature, process complex accounting activity, resolve variances, and/or document procedures to ensure accuracy of accounting information and/or financial reports, and/or compliance with established rules and/or regulations. Provide functional advice and/or training to less experienced accountants. Logistics: Companion Data Services, - one of the BlueCross BlueShield's South Carolina subsidiary companies. Location: This is a full-time position (40-hours/week) working an 8-hr shift Monday-Friday within the hours of 8:30am – 5:30pm on-site at 2401 Faraway Drive Columbia SC, in an office environment. What You'll Do: Prepares daily and/or monthly account reconciliations of a complex nature. Ensures work conforms to all contract/business regulations and/or instructions as well as generally accepted accounting principles, federal acquisition regulations, cost accounting standards and/or departmental policies. Maintains the General Ledger, processes the journal entries and/or generates the financial reports. Reviews, analyzes, and/or verifies complex accounting and/or system transactions. Identifies resolves and/or documents variances, and/or provides accounting information to operational areas to help them identify and/or resolve problems. Supports the month end, quarter end and/or year end close activities in accordance with internal procedures and/or established timelines. Completes assigned reports in accordance with established due dates and/or produces management reports for cost behavior, trends, variances, and/or other pertinent information applicable to the given line of business. Reconciles General Ledger accounts and/or processes adjusting entries in accordance with internal procedures, maintaining compliance with applicable regulations. Reviews and/or provides support to related account reconciliation activities performed in other accounting areas (subsidiary ledgers). May maintain current work instructions for all activities in the area. Reviews all departmental policies, procedures, and/or forms used by the department to identify areas of potential improvement in those documents. Suggests updates and/or improvements in those documents or prepare a preliminary draft of the policies including the updates or improvements as necessary. Assists Supervisor with special projects. Interfaces with internal and/or external audit agencies. Provides guidance and/or training to other accountants. Consults with other areas and/or gives advice on complex accounting principles. To Qualify for This Position, You'll Need The Following: Bachelor's in a job-related field with 24 semester hours in accounting. (Anyone hired prior to August 1, 2008, in an accounting position only requires 21 semester hours of accounting.) 5 years of accounting experience. Comprehensive knowledge of fundamental accounting concepts, practices and procedures. Possesses excellent communication, organizational and analytical skills. Ability to work independently. Microsoft Office. Ability to use data retrieval applications. We Prefer That You Have The Following: Proficiency in Microsoft Excel. Strong Analytical skills. Experience with Fixed Assets. Our Comprehensive Benefits Package Includes The Following : We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment: 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. What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 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 .

Summary Why should you join the BlueCross BlueShield 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: As member of the senior management team, the Chief Medical Officer provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. May also write and revise medical policies. Description Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at our Government Programs Building at 17 Technology Circle, Columbia, SC OR can be REMOTE in the United States. What You’ll Do: Supports operations in the form of case review on both medical and regulatory matters. Develops claim adjudication criteria for situations requiring medical judgment. Provides input on issues and operational policies, processes, and procedures. Educates staff and medical community on various aspects of medical policy and program administration. May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies. Develops external relationships with the medical community and serves as liaison between these entities and the contractors. Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. Conducts research into new or controversial medical procedures and technology. To Qualify for This Position, You'll Need the Following: Required Education: Doctoral degree Medical Doctor (MD) with current active license to practice medicine. Required Experience: Five years post graduate experience in direct patient care. Required Skills and Abilities: Excellent verbal and written communication skills. Excellent customer service, organizational, and presentation skills. Proficiency in spelling, punctuation, and grammar. Ability to persuade, negotiate, or influence others. Ability to work as a team member as well as a leader. Knowledge of medical and utilization review techniques. Required Software : Microsoft Office Software Required License and Certificate: Active state medical license and current board certification in a recognized specialty. We Prefer That You Have the Following: Knowledge of Durable Medical Equipment, Prosthetics, Orthotics and Supplies (DMEPOS) Medicare A/B MAC or DME MAC Three or more years in the healthcare insurance industry, a utilization form or other administrative experience in a health-related field that involved developing coverage and coding policies and guidelines. Experience involving development of coverage and coding policies and guidelines under a Medicare program contract is preferred. Our comprehensive benefits package includes the following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. 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 What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications. Pay Range Information: Range Minimum $206,011.00 Range Midpoint $309,767.00 Range Maximum $413,523.00 Pay Transparency Statement: Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity. 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 .