61 to 75 of 142
Provides prompt, accurate, thorough and courteous responses to all complex inquiries from Medicare Advantage members and providers. Inquiries are typically non routine and require deviation from standard screens, scripts, government websites and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty Medicare claims and/o
Posted 5 days ago
Performs clinical investigation of potential high cost claimants and performs Excess Loss Medical Assessment and High Dollar Forecast as needed. Provides support to underwriting, actuarial, and external customers in the form of monitoring and predicting ultimate losses for potential future high cost claimants. Supports cost containment through early identification and ref
Posted 5 days ago
Manages the technical support associates who support the claims standard processing system. Ensures the system is processing correctly; file maintenance including use of if then logic, testing of other components, problem research, security administration and also pricing. Contributes to achieving the goals for security and innovation. Description Directs and manages syst
Posted 5 days ago
Position Purpose As a member of the Palmetto GBA Accounting team you provide moderately complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging in general accounting, accounts payable, accounts receivable or related financial area. You c
Posted 6 days ago
Position Purpose As a member of the Palmetto GBA Accounting team you provide moderately complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging in general accounting, accounts payable, accounts receivable or related financial area. You c
Posted 6 days ago
Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources. Description Conducts internal and external timely operational, compliance, and financial audits of divisions, departments, providers, and activities of the corporation
Posted 6 days ago
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 administrator
Posted 6 days ago
Responsible for the most complex activities associated with maintaining ledger accounts and/or for developing financial statements and/or reports. Analyzes complex financial data and/or reports on the results and/or probable implications. Compiles financial information, processes journal entries into various accounts, and/or reconciles reports and/or financial data. Descr
Posted 6 days ago
Position Purpose As a member of our Medical Review Team, you will apply your skills and experience by performing medical reviews using clinical/medical information provided by physicians and providers. With this information, you will establish criteria/protocol sets or clinical guidelines, then document decisions using indicated protocol sets or clinical guidelines. This
Posted 6 days ago
Description What You'll Do Works closely with analysts and team members to understand benefit plan designs and business requirements. Based on approved design solutions, programs and / or performs quality control audits of specific benefit data structures, RULEs, reports, and / or testing scenarios utilizing enterprise server (Benefit Files, RULEs, AMMS, and claims. Devel
Posted 6 days ago
Position Purpose As a member of our Business Analysis team, you will be responsible for conducting business process analyses, needs assessments and preliminary cost/benefit analyses to align operations solutions with business initiatives. Your knowledge of business support and systems concepts skills will be used to provide assistance with testing efforts and may provide
Posted 6 days ago
BlueCross BlueShield of South Carolina
- Springfield, IL / Atlanta, GA / Burlington, VT / 42 more...
Responsible for providing a full range of financial, compliance, and operational audits, business advisory, and consultation services, investigations, internal controls, accountability, and use of resources. Description Logistics This role is a remote position. This position is full time (40 hours/week) Monday Friday. Employees are required to have a schedule during the h
Posted 6 days ago
Oversees an area responsible for claims, appeals, and/or customer service to ensure departmental performance guarantees are met. 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 C
Posted 6 days ago
Coordinates the quality control program for the medical review area. Researches the Center for Medicare and Medicaid services (CMS) changes. Trains new staff and provides continuing education to clinical staff. Description Reviews medical review decisions for accuracy and to ensure CMS instructions have been applied correctly. Develops/implements the quality control progr
Posted 6 days ago
Provides reinsurance support for new and renewal business, underwriting, claims audit/record keeping and/or other functions. May perform calculations and process general accounting requests for billing or payments, and/or check the status of claims and process policy changes. Provides customer service to clients and partners. Runs reports as needed. Description When a cas
Posted 6 days ago
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