Claims Processor II

BlueCross BlueShield of South Carolina

. Review and adjudicate complex or specialty claims .

Posted 10/22/2026full-timeNashville • Tennessee • United StatesJuniorMid-LevelWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in processing and adjudicating complex claims while adhering to organizational policies and regulations. Strong analytical, organizational, and communication skills are essential for effectively resolving claim issues and training new staff.

Highest-signal resume keywords

Claims AdjudicationClaims ProcessingAnalytical SkillsMicrosoft Office ProficiencyOrganizational Skills

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ReviewProcedure CodingDiagnosis CodingClaims VerificationClaims ResearchClaims AdjustmentBusiness Math

Soft Skills

Judgment SkillsOral CommunicationWritten CommunicationDiscretion

Industry Keywords

Claims RegulationsInternal StandardsQuality StandardsProduction Standards

About the role

Key responsibilities & impact

Review and adjudicate complex or specialty claims
Determine whether to return, deny or pay claims according to organizational policies and procedures
Assist in training or mentoring new staff members
Examine and process claims according to business/contract regulations, internal standards and examining guidelines
Enter claims into the claim system after verifying procedure and diagnosis coding
Verify claims have been keyed correctly
Ensure claims are processed according to quality and production standards
Correct processing errors by reprocessing, adjusting and/or recouping claims
Research and resolve claims edits and deferrals
Research claim problems using policies, procedures, reference materials and forms
Coordinate with internal support areas
Respond to routine correspondence and complete spreadsheets when applicable

Requirements

What you’ll need

High School Diploma or equivalent
2 years of experience processing, researching and adjudicating claims
Strong organizational, analytical and judgment skills
Strong oral and written communication skills
Proficient in spelling, punctuation and grammar
Proficient in basic business math
Ability to handle confidential or sensitive information with discretion
Microsoft Office proficiency
This position is not eligible for sponsorship now or in the future

Benefits

Comp & perks

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
Supplemental pay until enrolled in health benefits 28 days after the hire date