Information Technology Specialist

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, Position Purpose: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., * 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.

• Required Education: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.

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for 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.

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!