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Summary We are currently hiring for an Intensive Care Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as an Intensive Care Management Coordinator, you will serve as an Intensive Case Manager (ICM) for members identified with specific conditions and assist with imp

Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization

Summary This high-level proposal resource will participate in winning and retaining large clients, primarily designated to strategic RFPs and RFIs with a focus on strategy, storytelling, and high-quality responses. This role will collaborate with sales and account management resources to develop SWO

Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description Logistics: Planned Administrators Inc. (PAI) – One of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is fu

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 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 Responsible for maintaining the proper flow of the request for appeals.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

Summary 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 more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance

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. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description Location: This position is full-time (40-hou

Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical claims and utilization

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 Position Purpose: From the moment of login, you'll be focused on proac

Summary Companion Data Services provides leading IT solutions and managed services. We operate multiple geographically disperse data centers, including two of the nation’s largest healthcare data centers – both rated among the top five percent of data centers worldwide by MIPS.With three U.S. locati

Summary Prepares for and performs institutional audits to assess appropriate provider billing and to identify any aberrant billings that may have an impact on reimbursement. Responsible for reviewing all aspects of claim processing to include fraudulent billing practices and to respond to providers

Summary Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service. Description Position Purpose Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate clien

Summary 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 more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance

Summary This position is responsible for selling individual ACA policies. Experience selling on the Federally Facilitated Marketplace and the FFM certification strongly preferred.Responsible for providing consultative sales and service to customers seeking health and ancillary insurance products and

Summary Manages the provider enrollment unit ensuring the accurate and timely enrollment of providers, meeting all regulatory requirements, and maintains the national provider file database. Description Logistics: Palmetto GBA– one of BlueCross BlueShield's South Carolina subsidiary companies. Locat

Summary We are currently hiring for a Customer Service Advocate II to join BlueCross BlueShield of South Carolina. In this role as Customer Service Advocate II, you will provide prompt, accurate, thorough, and courteous responses to all customer inquiries. Inquiries may be non-routine and require de

Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description Location: This position is full-time (40-hou