Claims Processor II

BlueCross BlueShield of South Carolina

Claims Processor II reviewing and adjudicating complex specialty claims for BlueCross BlueShield's South Carolina operations. Assisting in training and mentoring team members within a collaborative environment.

Posted 5/1/2026full-timeColumbia • South Carolina • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

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.
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.

Requirements

What you’ll need

High School Diploma or equivalent
2 years of experience processing, researching and adjudicating claims.
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.
Microsoft Office proficiency.

Benefits

Comp & perks

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

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processingclaims adjudicationcoding proceduresdiagnosis codesquality standardsproduction standardserror correctionclaims researchbusiness math

Soft Skills

organizational skillsanalytical skillsjudgment skillsoral communicationwritten communicationdiscretion

Certifications

High School Diploma