BlueCross BlueShield of South Carolina

SummaryResponsible for providing a full range of compliance and operational audits business advisory and consultation services investigations internal controls accountability and use of resources.DescriptionThe Auditor is responsible for providing a full range of compliance and opera

SummaryResponsible for providing a full range of compliance and operational audits business advisory and consultation services investigations internal controls accountability and use of resources.DescriptionThe Auditor is responsible for providing a full range of compliance and opera

SummaryResponsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return deny or pay claims following organizatio

SummaryResponsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return deny or pay claims following organizatio

SummaryDescriptionWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve 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

SummaryDescriptionWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve 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

SummaryResponsible for providing a full range of financial compliance and operational audits business advisory and consultation services investigations internal controls accountability and use of resources.DescriptionThe Auditor is responsible for providing a full range of compliance

SummaryResponsible for providing a full range of financial compliance and operational audits business advisory and consultation services investigations internal controls accountability and use of resources.DescriptionThe Auditor is responsible for providing a full range of compliance

SummaryDescriptionLocation:This role is onsite at our Myrtle Beach SC location. Fulltime 40 hours/weekGovernment Clearance: This position requires the ability to obtain a security clearance which requires applicants to be a U.S. Citizen.SCA Benefit Requirements: BlueCross BlueShield o

SummaryDescriptionLocation:This role is onsite at our Myrtle Beach SC location. Fulltime 40 hours/weekGovernment Clearance: This position requires the ability to obtain a security clearance which requires applicants to be a U.S. Citizen.SCA Benefit Requirements: BlueCross BlueShield o

SummaryWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve 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 c

SummaryWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve 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 c

SummaryProvides supervision of staff performing quality control activities for department or line business.DescriptionLogistics: National Alliance one of BlueCross BlueShields South Carolina subsidiary companies.Location: This hybrid position is full-time (40-hours/week) Monday-Frida

SummaryProvides supervision of staff performing quality control activities for department or line business.DescriptionLogistics: National Alliance one of BlueCross BlueShields South Carolina subsidiary companies.Location: This hybrid position is full-time (40-hours/week) Monday-Frida

SummaryAnalyzes current and proposed policies procedures systems forms and reports for the department. Analyzes existing processes and procedures to recommend operational improvement through standardization simplification discontinuance or other methods. May recommend installations o

SummaryAnalyzes current and proposed policies procedures systems forms and reports for the department. Analyzes existing processes and procedures to recommend operational improvement through standardization simplification discontinuance or other methods. May recommend installations o

SummaryWe are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South this role as Appeals Specialist you will perform non-medical reviews make requested corrections on submitted claims and complete appeal decision letters.Why should you join the BlueCross Bl

SummaryWe are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South this role as Appeals Specialist you will perform non-medical reviews make requested corrections on submitted claims and complete appeal decision letters.Why should you join the BlueCross Bl

SummaryWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve 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 c

SummaryWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve 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 c

SummaryWe are currently hiring for an Appeals Analyst to join BlueCross BlueShield of South this role as Appeals Analyst you will research the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Additionally you will

SummaryWe are currently hiring for an Appeals Analyst to join BlueCross BlueShield of South this role as Appeals Analyst you will research the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Additionally you will

SummaryDevelops comprehensive reports and analyzes data in order to identify patterns and trends. Assists in creating materials that aid in illustrating analytical/data findings. Assists with sophisticated data interpretation compilation and verification to guide departmental efforts.

SummaryDevelops comprehensive reports and analyzes data in order to identify patterns and trends. Assists in creating materials that aid in illustrating analytical/data findings. Assists with sophisticated data interpretation compilation and verification to guide departmental efforts.

SummaryPerforms quality control audits to evaluate accuracy and effectiveness of departmental operations functions including but not limited to claims membership customer service/call center workflow processing support systems procedures documentation etc. Identifies problems analyze

SummaryPerforms quality control audits to evaluate accuracy and effectiveness of departmental operations functions including but not limited to claims membership customer service/call center workflow processing support systems procedures documentation etc. Identifies problems analyze

SummaryWe have a job opening for the Consumer Experience and Market Solutions Summer Student Intern position with at BlueCross BlueShield of South Carolina. The Intern position is utilized for training an active high school or college student towards an entry level role. The responsi

SummaryWe have a job opening for the Consumer Experience and Market Solutions Summer Student Intern position with at BlueCross BlueShield of South Carolina. The Intern position is utilized for training an active high school or college student towards an entry level role. The responsi

SummaryPerforms validation reviews of Diagnosis Related Groups (DRG) Adaptive Predictive Coding (APC) and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports out

SummaryPerforms validation reviews of Diagnosis Related Groups (DRG) Adaptive Predictive Coding (APC) and Never Events (inexcusable outcomes in a healthcare setting) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports out

SummaryResponsible for assisting in the execution of financial compliance and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans policies and procedures prescribed by management. Reviews assi

SummaryResponsible for assisting in the execution of financial compliance and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans policies and procedures prescribed by management. Reviews assi

SummaryResponsible for identifying training needs developing training materials and facilitating training. Provides training guidance and leadership for new training specialists. Develops performance assessments and testing materials. Manages trainees and communicates effectively with

SummaryResponsible for identifying training needs developing training materials and facilitating training. Provides training guidance and leadership for new training specialists. Develops performance assessments and testing materials. Manages trainees and communicates effectively with

SummaryProvides education and training support for network providers/staff/suppliers/physicians/beneficiaries/referral agents as necessary. Develops and produces training and educational materials.Why should you join the BlueCross BlueShield of South Carolina family of companies Other

SummaryProvides education and training support for network providers/staff/suppliers/physicians/beneficiaries/referral agents as necessary. Develops and produces training and educational materials.Why should you join the BlueCross BlueShield of South Carolina family of companies Other

SummaryDescriptionWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve 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

SummaryDescriptionWhy should you join the BlueCross BlueShield of South Carolina family of companies Other companies come and go but weve 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

SummaryWorking at CGS AdministratorsCGS Administrators provides a variety of services under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries health care providers and medical equipment suppliers in 33 states supporting the needs of more than 20 mil

SummaryWorking at CGS AdministratorsCGS Administrators provides a variety of services under contracts with the Centers for Medicare and Medicaid Services (CMS) for beneficiaries health care providers and medical equipment suppliers in 33 states supporting the needs of more than 20 mil