Claims Processor Jobs in Darlington, SC (NOW HIRING)

Summary Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements. Description Location This role is full time M-F 8am-5pm, onsite at our Florence, SC location. Government 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 of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. What You Will Do: Performs routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed Recognizes and documents any potential fraud and abuse situations. May provide one on one guidance to new hires upon completion of initial training Provides necessary feedback or coaching to operations and training areas on errors assessed so that additional training can be initiated as needed Compiles data and generates reports for operations areas on quality performance Identifies areas of weakness and communicates recommendations on changes and improvements to training materials Documents findings of analysis and prepares recommendations for implementation of new systems, procedures or organizational changes Assists with training documentation and development of new processes and procedures Remains current with all guidelines, work instructions, etc To Qualify for This Position, You Will Need: Required Education: High School Diploma OR equivalent Required Work Experience: One (1) year of related claims processing, customer service, auditing, training, analysis, or operations experience. Required Software and tools: Microsoft Office Required Skills and Abilities: Good analytical, customer service, and organization skills. Basic business math proficiency. Able to document problems and assist in their resolution. Able to document processes and identify areas for improvement. Effective written and verbal communication skills. Strong business math proficiency. Able to document problems and assist in their resolution. Able to document processes and identify areas for improvement. Strong written and verbal communication skills What We Prefer: 1 year-of experience in a healthcare or insurance industry. What We Can Do for You: 401(k) retirement savings plan with company match Subsidized health plans and free vision coverage Life insurance Paid annual leave - the longer you work here, the more you earn Nine paid holidays On-site cafeterias and fitness centers in major locations Wellness programs and healthy lifestyle premium discount Tuition assistance Service recognition Incentive Plan Merit Plan Continuing education funds for additional certifications and certification renewal Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Welcome Here's Your Smart Career Move Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. Business and political climates may change, but we're stronger than ever. Our A+ (Superior) - making us the only health insurance company in South Carolina with that rating. We're the largest insurance company in South Carolina ... and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We've found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. #J-18808-Ljbffr