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. What You’ll Do Verify necessary 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 mass rate updates, quality improvement, audits, etc. Location & Schedule Full-time (40 hours/week), Monday‑Friday, 8:00 AM‑5:00 PM. Onsite at 17 Technology Circle, Columbia, SC 29203. Overtime or travel between buildings may be required. Sponsorship: This position is not eligible for sponsorship now or in the future. Required Qualifications High School Diploma or equivalent. At least 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience. Proficiency with Microsoft Office and basic business math. Working knowledge of word processing and spreadsheet software. Good judgment, effective customer service, organizational skills, and excellent verbal and written communication. Ability to handle confidential or sensitive information with discretion. Basic understanding or ability to acquire PIMS. Preferred Qualifications Experience with DB2 or SQL to create/run PIMS queries for QC/research purposes. Strong telephone customer service skills. Quality and auditing experience. Benefits Health, dental, and vision coverage. 401(k) retirement savings plan with company match. Life insurance. Paid Time Off (PTO). On-site cafeterias and fitness centers at major locations. Education assistance. Employee recognition programs. National discounts. EEO Statement BlueCross BlueShield of South Carolina is an equal opportunity employer. We maintain a continuing policy of nondiscrimination in employment and comply with all applicable federal, state, and local laws and regulations. #J-18808-Ljbffr 001 BlueCross and BlueShield of South Carolina