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Information Technology Specialist
BlueCross BlueShield of South Carolina. Process denials of claims . Process adjustment claims for pre-pay and post-pay departments . Investigate and analyze adjustment claim history and denial records . Prescreen records for review and maintain accurate
Core Competencies
Role fitCore Competencies
Use this summary to align your resume positioning with the role.
Demonstrates proficiency in processing claims and managing denial records while maintaining accurate documentation. Strong analytical and communication skills are essential for effective collaboration with providers and ensuring quality control in claims processing.
Highest-signal resume keywords
Claims ProcessingAnalytical SkillsMicrosoft Office ProficiencyCustomer Service SkillsAdministrative Support Experience
ATS Keywords
Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills
Claims Denial ProcessingAdjustment Claims ProcessingQuality ControlRecord MaintenanceData Analysis
Soft Skills
Organizational SkillsVerbal Communication SkillsWritten Communication SkillsGood JudgmentDiscretion
Tools & Technologies
Word Processing SoftwareMicrosoft Office
Certifications & Qualifications
Associate's Degree
Industry Keywords
Claims ManagementMedical ReviewProvider CommunicationConfidential Information Handling
About the role
Key responsibilities & impact- Process denials of claims
- Process adjustment claims for pre-pay and post-pay departments
- Investigate and analyze adjustment claim history and denial records
- Prescreen records for review and maintain accurate claims records
- Communicate with providers and assist the provider service department with inquiries
- Generate educational correspondence to providers regarding denials
- Perform quality control of work processes
- Assist the manager with special projects
- Maintain records and process claims in medical review
- Process incoming and outgoing mail and prepare work for nursing staff
- Troubleshoot claims before and after nurse review
- Monitor claims-processing timeliness and adjust incorrectly keyed claims
Requirements
What you’ll need- Associate's degree required
- 2 years job related work experience as degree equivalency
- 1 year administrative/clerical support experience
- Working knowledge of word processing software
- Strong analytical, organizational, and customer service skills
- Strong verbal and written communication skills
- Proficiency in spelling, punctuation, and grammar skills
- Good judgment skills
- Ability to handle confidential or sensitive information with discretion
- Microsoft Office proficiency
- 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