Blue Cross Blue Shield
The role is a strategic leader accountable for driving insights that inform competitive positioning across government programs (ex. Medicare, Medicaid) market segments. Shapes business strategies by overseeing the design and analysis of custom research. Synthesizes findings and presents to executive…
Summary =========== Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Why should you join the BlueCross BlueShield of…
Summary =========== Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions…
Job Description Summary: The Data Governance and Emerging Technologies Counsel partners across the organization to provide legal and strategic guidance on initiatives involving data use, privacy, and advanced technologies such as artificial intelligence, machine learning, and analytics. This role supports…
Summary =========== 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…
Summary =========== We have a job opening for the position of Business Management Summer Student Intern at Palmetto GBA, a subsidiary of BlueCross BlueShield of South Carolina. The Intern position is utilized for training an active high school or college…
Summary =========== Researches the substance of complex appeal or retrospective review requests including pre pay and post payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documents decisions…
Summary =========== Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description =============== Location: This position is full time (40 hours/week) Monday Friday in a typical office environment. You will work…
Summary =========== Provides education and training support for network providers/staff/suppliers/physicians/beneficiaries/referral agents as necessary. Develops and produces training and educational materials. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've…
Summary =========== Provides prompt, accurate, thorough and courteous responses to all telephone inquiries. Performs research as needed to resolve inquiries. Description =============== Location: This position is full time (40 hours/week) Monday Friday in a typical office environment. This role is…
Summary =========== Performs validation reviews of Diagnosis Related Groups (DRG), Adaptive Predictive Coding (APC), and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining…
Summary =========== We have a job opening for the Consumer Experience and Market Solutions Summer Student Intern position with at BlueCross BlueShield of South Carolina. The Intern position is utilized for training an active high school or college student towards…
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…
Summary =========== Responsible for the accurate and timely processing of claims. Description =============== Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full time (40 hours/week) Monday Friday from 8:00am 5:00pm in a typical…
Summary =========== Creates and analyzes reports to support operations. Ensures correctness of analysis, and reports findings in a concise manner to senior management. Directly responsible for accuracy of data as financial and operational decisions are made based on the data…
Summary =========== 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…
Summary =========== Responsible for the accurate and timely processing of claims. Description =============== Logistics: PGBA 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…
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…
Our Head of Enterprise Architecture and Enterprise Common Technology Services provides strategic and technical leadership for the organization’s enterprise technology ecosystem. This role ensures that IT investments, platforms, and architectures align with business strategy, enable interoperability, and promote scalability, security,…
Summary =========== Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions…
Summary =========== Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care management interventions…
Summary =========== Responsible for supporting and maintaining the coordination of daily operations of assigned area. Interfaces with the medical management on a regular basis to work more complex UR cases for the outpatient UR function. Description =============== National Alliance –…
Summary =========== 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…
Summary =========== Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description =============== Logistics: Palmetto GBA – one of…
Summary =========== Responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. Maintains the timely, complete, and accurate processing of authorization requests by interfacing with internal and external customers and the Pharmacy Benefit…
Summary =========== We are currently hiring for a Managed Care Coordinator to join BlueCross BlueShield of South Carolina. In this role as Managed Care Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services…