Reviewer II, Medical

BlueCross BlueShield of South Carolina

Performs medical reviews using clinical and medical information provided by physicians. Reviews medical claims and documents decisions using established clinical guidelines.

Posted 7/9/2026full-timeRemote • Alabama, North Carolina, South Carolina • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Perform medical claim reviews for claims requiring preauthorization or appeals
Determine medical necessity and appropriateness for coverage and reimbursement
Document medical rationale for payment or denial of services
Educate staff on medical reviews, coverage determinations, and coding procedures
Participate in quality control activities

Requirements

What you’ll need

Associate's in a job related field
Active RN licensure in state hired, OR, active compact multistate RN license as defined by the Nurse Licensure Compact (NLC)
2 years clinical experience
Working knowledge of word processing software
Ability to work independently, prioritize effectively, and make sound decisions
Good judgment skills
Demonstrated customer service and organizational skills
Demonstrated oral and written communication skills
Analytical or critical thinking skills
Ability to handle confidential or sensitive information with discretion
Microsoft Office proficiency

Benefits

Comp & perks

401(k) retirement savings plan with company match
Subsidized health plans, dental and vision coverage
Life insurance
Paid Time Off (PTO)
Nine paid holidays
On-site cafeterias and fitness centers in significant locations
Wellness programs and a healthy lifestyle premium discount
Tuition assistance
Service Recognition

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills & Tools

Medical Claim ReviewCoverage DeterminationDocumentation SkillsCoding ProceduresClinical Experience

Soft Skills

Good Judgment SkillsOrganizational SkillsOral Communication SkillsWritten Communication SkillsCritical Thinking Skills

Certifications

Active RN LicensureCompact Multistate RN License