Blue Cross Blue Shield
Job Description As a Consulting Actuary ACA Risk Adjustment, you will play a pivotal role in delivering a wide array of actuarial and analytical services for our organization. Responsibilities include leading pricing strategies and actuarial initiatives for business segments, evaluating…
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 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 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 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 completion of the initial credentialing and re credentialing process of providers to the network for various lines of business across the company. Maintains credentialing database and ensures provider databases are current and accurate. Provides assistance…
Summary =========== We are currently hiring for a Part Time Claims Customer Service Advocate II to join BlueCross BlueShield of South Carolina. In this role as a Claims Customer Service Advocate II, you will be responsible for helping our customers…
Summary =========== Develops test plans and test matrices, conducts testing and reports test results for system changes. Coordinates implementation and debugging of new software ensuring that the new or modified applications work in the production environment and meet the expectations…
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 8am 5pm in a typical…
Summary =========== Responsible for daily workflow activities to include the following membership/enrollment activities: processing of applications for new enrollments, terminations/cancellations, changes, renewals, and database updates. Description =============== Logistics: This is a full time (40 hours/week) position, Monday Friday in office…
Summary =========== Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Description =============== PGBA – is a subsidiary company of BlueCross BlueShield of South…
Job Description Blue Cross NC is looking for an exceptional Principal Marketing & Print Category Management Analyst to shape innovative supplier strategies, oversee critical sourcing initiatives, and cultivate influential partnerships. This exciting role offers the opportunity to manage high impact…
Summary =========== We are currently hiring for a Behavioral Health Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Behavioral Health Case Management Coordinator, care management interventions focus on improving care coordination and reducing…
Summary =========== We are currently hiring for a Managed Care Coordinator I to join BlueCross BlueShield of South Carolina. In this role as a Managed Care Coordinator I, you will review and evaluate medical or behavioral eligibility regarding benefits and…
Summary =========== Responsible for oversight of the corporate salary administration program to include design, implementation, and administration of compensation programs that promote internal equity and external market competitiveness. Description =============== Location: This position is full time (40 hours/week) Monday Friday…
Summary =========== We are currently hiring for a Behavioral Health Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role as a Behavioral Health Care Management Supervisor, you will be responsible for the supervision and maintenance of…
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 =========== Job Description Summary We are currently hiring for a Part Time Claims Customer Service Advocate II to join BlueCross BlueShield of South Carolina. In this role as a Claims Customer Service Advocate II, you will be responsible for…
Summary =========== Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description =============== Location: This position is…
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 =========== Assists with health management activities/programs for BlueCross BlueShield of South Carolina (BCBSSC) and/or Blue Choice members. Description =============== Job Description Location: This position is full time (40 hours/week) Monday Friday, from 8:00am – 4:30pm and will be hybrid…
Summary =========== Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization practices. Description =============== Logistic:…
Summary =========== Defines customer needs in technical and business contexts. Ensure the proposed technical and business solutions meet the customer's objectives for the work effort. Provide guidance with planning and prioritization of business support related activities. Description =============== Position Purpose:…
Summary =========== Description =============== 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…
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 =========== Develops and delivers sales, service, and product training to sales and service representatives in all sales channels and independent sales agents. Assists representatives in effectively acquiring and retaining business from small groups and individual customers. Description =============== Location:…
Summary =========== Description =============== 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…
Summary =========== Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or…
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…
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 =========== Description =============== 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…
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…