ourhrconnect

Summary Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outlining trends. Serves a

Summary Ensures the accuracy and quality of data that had been systematically or manually entered into an indexing system. Description 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 mo

Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description Logistics: CGS - One of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40 hours/week) Monday

Summary Responsible for performing comprehensive medication reviews and outreach to inform and educatepatients and their providers about opportunities to optimize medication related outcomes, ensurepatient safety, and utilize cost effective therapies. Collaborates with other health professionals to

Summary Job Description SummaryWhy 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 larges

Summary Conducts market research to support product and program development, strategic planning and market growth initiatives. Leads implementation and evaluation of marketing projects, providing recommendations for product enhancements and performance optimization. Oversees the Medicaid Extra Benef

Summary 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

Summary 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

Summary Depending on department needs, this job includes the following: cashier, prep cook, food server, dishwasher/pot washer, catering delivery, restocking as needed, and any other need as asked by management.Why should you join the BlueCross BlueShield of South Carolina family of companies? Other

Summary 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

Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description Logistics - Palmetto GBA - one of BlueCross BlueShield of South Carolina’s subsidiary companies. Location: This position is a full-time (40-hou

Summary We are currently hiring for an RN Medical Reviewer III to join BlueCross BlueShield of South Carolina. In this role as an RN Medical Reviewer III, you will perform medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or cl

Summary Responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. Maintains the timely, complete, and accurate processing of authorization requests by interfacing with internal and external customers and the Pharmacy Benefit Man

Summary Provides prompt, accurate, thorough and courteous responses to all telephone inquiries. Performs research as needed to resolve inquiries. Description Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. This role is located on-site at 200 North

Summary We are currently hiring a Part A/HHH Appeals Specialist at one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans, Medicaid members, Med

Summary Responsible for the accurate and timely processing of claims. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm. This role is located on-site at 200 N Dozier B

Summary Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Description Logistics: PGBA – is a subsidiary company of BlueCross BlueShield of S

Summary 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

Summary Responsible for operating high speed, file based integrity production mail inserters and other print/mailing equipment to meet the company’s required contractual obligations related to mailing first-class correspondence, statements, checks, etc.*Mail procedures require the adherence to the U

Summary We are currently hiring for a Managed Care Coordinator I to join BlueCross BlueShield of South Carolina. In this role as a Managed Care Coordinator I, you will review and evaluate medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, admin