Florence, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1049864 Summary Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call cent...
6h
| Job Type | Full Time |
Utilization Management Pharmacist
Columbia, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1051274 Summary Responsible for performing utilization management reviews of prior authorization request for medications by applying clinical guidelines and criteria to ensure appropriate use of medications. Info...
6h
| Job Type | Full Time |
Pharmacy Technician - Prior Authorization Focus
Columbia, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1051195 Summary Responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. Maintains the timely, complete, and accurate processing of authori...
6h
| Job Type | Full Time |
Dallas, Texas
BlueCross BlueShield of South Carolina
Internal Reference Number: R1049782 Summary Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service.Description Position Purpose: Au...
6h
| Job Type | Full Time |
Claims Technician - PGBA (Part-Time)
Florence, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1051234 Summary Performs routine but varied clerical duties in accordance with standard procedures. This includes clerical duties such as photocopying, compiling records, filing, tabulating, posting information, ...
6h
| Job Type | Part Time |
Columbia, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1050523 Summary Reviews and adjudicates complex or specialty claims. Determines whether to return, deny or pay claims following organizational policies and procedures. Assists in training or mentoring new staff m...
6h
| Job Type | Full Time |
Internal Financial Controls Analyst
Columbia, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1051188 Summary Supports the Model Audit Rule (MAR/SOX) Department in the compliance effort that results in annual reporting to the Department of Insurance in activities such as, but not limited to: risk assessme...
6h
| Job Type | Full Time |
Claims Customer Service Advocate III
Columbia, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1050582 Summary Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedu...
6h
| Job Type | Full Time |
Myrtle Beach, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1050647 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 adj...
6h
| Job Type | Full Time |
Columbia, South Carolina
BlueCross BlueShield of South Carolina
Internal Reference Number: R1050728 Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs r...
6h
| Job Type | Full Time |