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 This position is remote. Conduct internal and/or external timely operational, financial, and/or compliance audits of divisions, departments, providers, an

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 return, deny or pay claims following organizational policies and procedures. Description Work

Provides supervision and direction of the statistical reporting function. Ensures adherence to external and/or internal requirements and guidelines as they relate to data reporting functions. Description Monitors adherence to statistical reporting requirements, updates systems as necessary. Sets and maintains general direction/focus of statistical reporting function . Sup

Involved in all aspects of the Molecular Diagnostic Program (MoIDX) laboratory operations and serves as an internal subject matter expert, applying medical knowledge to advise decision makers in support of MoIDX's mission. Responsible for review and approval of documentation and reports, supporting clinical testing strategies, as well as new assay development and validati

Position Purpose As a member of our onsite Appeals Specialist Team located in Augusta Georgia, you will use your knowledge, skills, and experience to perform non medical reviews and processes redetermination letters. Description What You'll Do Perform non medical reviews and processes redetermination letters ensuring timeliness and accuracy. Prepare unit reports, analyzes

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 specialty claims and/or non medical appeals. Determines whether to return, deny or pay c

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, case management interventions are intended to enhance client safety, well being, and quality of life. These in

This role directly helps our customers by providing prompt, accurate, thorough and courteous responses to all customer inquiries. This job may require research to resolve these inquiries. Description What You'll Do You will provide effective customer relations by responding accurately, timely and courteously to telephone, written, web or walk in inquiries. All inquiries w

Supports actuarial services by providing research data, reports, and analysis of the profitability of existing and new lines of business. Description Assists with statistical and reporting functions, regulatory reporting, data testing, and research. Prepares and updates actuarial models and reconciles with financial statements. Performs basic analysis of the rates and rat

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

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

Provides financial reconciliations and reports/analysis of Medicare Trust Fund activities to support government requirements. Prepares/documents complex financial analysis projects following standard practices and procedures. Extracts financial data from various accounting and information systems. Performs financial analysis of data. Description Reviews and/or prepares fi

Provides blended learning solutions and the use of innovative technology and tools to meet business goals. Responsible for training, developing and coaching activities in various areas. This includes the analysis, design, delivery, evaluation and maintenance required to manage the on going execution of training programs and expected outcomes. Description Facilitates varyi

Provides blended learning solutions and the use of innovative technology and tools to meet business goals. Responsible for training, developing and coaching activities in various areas. This includes the analysis, design, delivery, evaluation and maintenance required to manage the on going execution of training programs and expected outcomes. Description Facilitates varyi

Responsible for identifying training needs, developing training materials and facilitating training. Provides training, guidance and leadership for new training specialists. Develops performance assessments and testing materials. Manages trainees and communicates effectively with area management on trainee performance. Description Leads, plans and prioritizes training pro