Provider File Specialist I

Summary Responsible for establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing. Why Join BlueCross BlueShield of South Carolina? 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 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Location & Work Hours This position is full-time (40 hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00 AM–5:00 PM. It may be necessary, given the business need, to work occasional overtime. You may be required to travel between buildings. This role is located onsite at 200 North Dozier Boulevard Florence, SC 29501. Sponsorship This position is not eligible for sponsorship now or in the future. 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). As a Service Contract Act employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment. What You'll Do Verify necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or establish certification of healthcare service providers. Prepare provider files/maintain provider data (updates, additions, deletions) on the provider information management system (PIMS) or appropriate provider system/database. Identify/assign providers to the appropriate network and provider system/database. Contribute to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports. Contribute to and participate on special projects, which may include but are not limited to mass rate updates, quality improvement, audits, etc. Qualifications Required: High School Diploma or equivalent. Required: 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience. Required: Working knowledge of word processing and spreadsheet software. Required: Knowledge/understanding of or ability to acquire PIMS. Required: Good judgment skills. Required: Effective customer service and organizational skills. Required: Demonstrated verbal and written communication skills. Required: Basic business math proficiency. Required: Ability to handle confidential or sensitive information with discretion. Required: Microsoft Office. Preferred: Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes. Preferred: Excellent telephone skills and previous customer service experience. Benefits Subsidized health plans, dental and vision coverage. 401(k) retirement savings plan with company match. Life Insurance. Paid Time Off (PTO). On-site cafeterias and fitness centers in major locations. Education Assistance. Service Recognition. National discounts to movies, theaters, zoos, theme parks and more. #J-18808-Ljbffr