Manager, Claims Operations

Internal Reference Number: R1050216 Manages a team of associates responsible for the accurate and timely processing and adjudication of claims. Logistics Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. Location 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 8:30AM-5:30PM. This role is located at 2743 Perimeter Parkway, Augusta, GA 30909. What You'll Do Monitors and evaluates one or more units to ensure the accurate and timely processing of claims. Develops effective claims processing standards that incorporate the use of automated claims systems and other technology solutions. Ensures compliance with all applicable laws, regulations, and contract requirements while meeting performance expectations. Monitors all reports and quality audits to ensure the efficient operation of the department. Ensures proper training for new and current staff. Maintains a high level of customer service with all internal and external customers. Interacts regularly with internal departments for planning, training, and management purposes. To Qualify For This Position, You'll Need The Following Required Education: Bachelor's Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience (Equivalency not applicable for the Celerian Group. Bachelor's degree required.) Required Work Experience: 4 years of claims processing experience, including either 2 years of lead or supervisory experience OR 2 years of equivalent military experience in grade E4 or above. Required Skills and Abilities: Analyzes claims deferrals Diagnoses claims issues Enters claims data Reviews work from others Uses sound reasoning when processing claims We Prefer That You Have The Following Preferred Software and Other Tools: Microsoft Office. Benefits Our comprehensive benefits package includes the following: Subsidized health plans, dental and vision coverage 401k 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 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 View email address on click.appcast.io or call View phone number on click.appcast.io 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. #J-18808-Ljbffr