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Summary 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. Description Position Purpose Reviews and adjudicates complex or specialty claims. Determ

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 8am-5pm in a typical office environment. This role is located

Summary 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

Summary Provides education to medical providers as warranted. Description Logistics: Palmetto GBA– one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This a full-time remote position for South Carolina, North Carolina, Georgia and Alabama candidates. You will work an 8-hour

Summary We’re hiring a Web Business Specialist to help manage and improve our enterprise websites, portals, and digital experiences. You’ll update web content and proactively review it to ensure it meets our standards and remains consistent, compliant, accessible, and high quality. This role require

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