Processor, Claims II

Claims ExaminerSummary Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff members.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-4:00pm CST. This role is located at 26 Century Blvd Suite ST610 Nashville, TN 37214.What You'll Do: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.To Qualify for This Position, You'll Need the Following:Required Education: High School Diploma or equivalentRequired Work Experience: 2 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.Our Comprehensive Benefits Package Includes the Following:Subsidized health plans, dental and vision coverage401k retirement savings plan with company matchLife InsurancePaid Time Off (PTO)On-site cafeterias and fitness centers in major locationsEducation AssistanceService RecognitionNational discounts to movies, theaters, zoos, theme parks and moreEqual Employment Opportunity StatementBlueCross 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.