Qureos Mentor

Blue Cross Blue Shield

<div><h1 class="jobSectionHeader">Summary
 
</h1>Palmetto GBA is one of the nation&rsquo;s largest providers of high-volume claims and transaction processing, contact center operations, and technical services to the federal government and other commercial customers. Our core business is providing services to CMS Medicare beneficiaries, providers, and health plans.
 
 
Our team leads the organization&rsquo;s statistics, data analysis, and research functions. We support strategic decision making by delivering high quality analytics, actionable insights, and data driven recommendations. We work closely with cross functional partners to improve performance, measure outcomes, and strengthen organizational learning.
 
 
Our culture is collaborative, curious, and mission driven. We value analytical rigor, integrity, and continuous improvement. Team members support each other through open communication, shared problem solving, and a commitment to professional growth. We encourage creativity in methodological approaches, welcome diverse perspectives, and maintain a positive and respectful work environment.
<h1 class="jobSectionHeader"> 
Description 
 
</h1><div></div><div><div><div><div><div><div><div><div>Logistics: Palmetto GBA &ndash; one of BlueCross BlueShield's South Carolina subsidiary companies.
<div>Position Purpose :
Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to identify and explain data findings.
</div></div></div></div></div></div></div></div></div>What You&rsquo;ll Do :
<ul><li>Develops, maintains, and executes complex database programs for the extraction and presentation of data for standard and ad hoc reporting. Creates supporting documentation outlining all procedures within scope of responsibility.
</li><li>Develops complex sampling design and/or execution methodology for sample selection.
</li><li>Develops difficult statistical analysis using standard reporting, ad hoc reporting, and data mining tools. Provides sophisticated data interpretation, compilation, and verification to guide departmental efforts.
</li><li>Prepares charts, illustrations, and other graphics and narrative reports to identify and explain patterns and trends.
</li><li>Participates in writing of articles suitable for internal/external publication to support departmental efforts. May assume a leadership role in this activity.
</li><li>Provides assistance in development of project plans and system life cycle maintenance, performing quality checks on relational database tables, and in the development of focused end-user applications.
</li><li>With leadership responsibilities as assigned by management, participates in development of change requests and testing plans for changes to existing relational database tables. Researches new sources of data and provides written and/or verbal feedback to management.
</li></ul>To Qualify for This Position, You&rsquo;ll Need the Following :
Required Education:
<ul><li>Bachelor's in a job related field
</li></ul>Required Work Experience:
<ul><li>Four years statistical programming or statistical interpretation.
</li></ul>Required Skills and Abilities:
<ul><li>Strong organizational, customer service, and analytical skills.
</li><li>Ability to use complex mathematical calculations.
</li><li>Demonstrated knowledge of mathematical or statistical concepts.
</li><li>Relevant computer programming skills. 
</li></ul> 
Required Software and Tools:
<ul><li>Microsoft Office.
</li></ul>We Prefer That You Have the Following :
<ul><li>Experience with Prior Auth programs and Review Choice Demonstration reporting.
</li><li>Python experience
</li><li>Develop and maintain SAS programs for analyzing Medicare claims data and identifying trends in medical claims.
</li><li>Conduct data extraction, manipulation, and validation using PROC SQL, PROC REPORT, PROC TABULATE, and macro programming.
</li><li>Code, maintain, and execute database programs for the extraction and presentation of data for standard and ad hoc reporting.
</li><li>Develop supporting material and guidelines on report design and resulting data.
</li><li>Perform statistical analysis and hypothesis testing for fraud detection and risk assessment.
</li><li>Ensure compliance with industry standards, data integrity, and regulatory reporting requirements.
</li><li>Collaborate with cross-functional teams to optimize reporting workflows and develop submission-ready datasets.
</li><li>Good oral and written communication skills.
</li><li>Computer systems support knowledge.
</li><li>SAS, Business Objects, and/or DB2 or other relational database.
</li></ul>What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
Our comprehensive benefits package includes:
<ul><li>Subsidized health plans, dental and vision coverage
</li><li>401K retirement savings plan with company match
</li><li>Life Insurance
</li><li>Paid Time Off (PTO)
</li><li>Nine paid holidays
</li><li>On-site cafeterias and fitness centers in major locations
</li><li>Wellness program and healthy lifestyle premium discount
</li><li>Tuition assistance
</li><li>Service recognition
</li><li>Employee Assistance
</li><li>Discounts to movies, theaters, zoos, theme parks and more
</li></ul>What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who qualify with prioritization given to those candidates who demonstrate the preferred qualifications.
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 mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 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. Here's more information .
Some states have required notifications. Here's more information .</div>

Statistical Programming Analyst III - Palmetto GBA

<div><h1 class="jobSectionHeader">Summary
 
</h1>Maintains all quality management system documentation at the company level. Assists and trains functional document control administrators and management in documenting procedures in accordance with certification standards. Provides support for the Quality Management System (QMS).
<h1 class="jobSectionHeader"> 
Description
 
</h1><h2 class="jobSectionHeader">This is a fulltime position reporting to 17 Technology Circle in Columbia, SC. This role is hybrid with three remote days and two mandatory onsite days.
</h2>What You'll Do:
<ul><li>Provide weekly metrics on new, in progress, and completed medical records requests
</li><li>Maintain a consistent workflow by processing all requests within 24-48 hours of receipt for assigned medical records tickets
</li><li>Manage, organize, copy, scan, and analyze medical records to ensure accuracy, integrity, and timely fulfillment of medical record requests.
</li><li>Travel to providers offices to complete medical record request vis Electronic Medical Records Systems
</li><li>Manage electronic and physical records, ensure compliance with federal regulations and agency directives, and support the full records lifecycle from creation to disposition
</li><li>Stay up-to-date with medical records and health information release regulations (e.g., HIPAA) to ensure accurate processing.
</li><li>Provides document control administrator and management training and support for QMS. Ensures all document control procedures are understood, followed, and improved as needed.
</li><li>Updates ISO 9000 and quality management documentation at the company level. Maintains files, records, and documentation in accordance with certification standards.
</li><li>Works with vendor, document control administrators, and management to maintain and enhance the QMS documentation system as well as to maintain, develop and test any enhancements.
</li><li>Compiles performance metric reports, management review reports, and score cards.
</li><li>Provides documentation control for management review meetings. Prepares and distributes minutes and task list.
</li><li>Plans internal/external audits. Performs documentation audits for auditors. Documents audit findings in a final report presentation
</li></ul>What You'll Need:
Required Education: Bachelor's
 
 
Degree Equivalency: 4 years of related work experience.
 
 
Required Work Experience: 3 years of experience working in quality management systems such as ISO 9000, TQM, Baldrige, CMMI, COPC, NCQA or URAC.
 
 
Skills and Abilities: Strong organization, judgment, customer service, persuasion, and communication skills. Knowledge of the ISO 9000 system elements and/or Total Quality Management (TQM). Ability to use software applications to develop training materials.
 
 
Preferred Skills and Abilities: Excellent presentation skills. Strong analytical skills. Computer systems support knowledge. Knowledge of mathematical or statistical concepts and the ability to use complex mathematical calculations.
 
 
Preferred Licenses and Certificates: Certified Quality Improvement Associate or other quality certification. 
<h2 class="jobSectionHeader"> 
Work Environment: Typical office environment.
</h2><h2 class="jobSectionHeader">Our Comprehensive Benefits Package Includes The Following : We offer our employees great benefits and rewards. You will be eligible to participate in the benefits at the first of the month following 28 days of employment:
</h2><ul><li><h2 class="jobSectionHeader">Subsidized health plans, dental and vision coverage
</h2></li><li><h2 class="jobSectionHeader">401k retirement savings plan with company match
</h2></li><li><h2 class="jobSectionHeader">Life Insurance
</h2></li><li><h2 class="jobSectionHeader">Paid Time Off (PTO)
</h2></li><li><h2 class="jobSectionHeader">On-site cafeterias and fitness centers in major locations
</h2></li><li><h2 class="jobSectionHeader">Education Assistance
</h2></li><li><h2 class="jobSectionHeader">Service Recognition
</h2></li><li><h2 class="jobSectionHeader">National discounts to movies, theaters, zoos, theme parks and more
</h2></li></ul><h2 class="jobSectionHeader">What We Can Do for You:
</h2><h2 class="jobSectionHeader">We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company
</h2><h2 class="jobSectionHeader">What To Expect Next:
</h2><h2 class="jobSectionHeader">After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
</h2><h2 class="jobSectionHeader">Equal Employment Opportunity Statement
</h2><h2 class="jobSectionHeader">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.
</h2><h2 class="jobSectionHeader">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.
</h2><h2 class="jobSectionHeader">If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
</h2><h2 class="jobSectionHeader">We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.
</h2><h2 class="jobSectionHeader">Some states have required notifications. Here's more information .
</h2>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 mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 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. Here's more information .
Some states have required notifications. Here's more information .</div>

MA, Quality Management Coordinator

<div><h1 class="jobSectionHeader">Summary
 
</h1>Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we&rsquo;ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina &hellip; and much more. We are one of the nation&rsquo;s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
<h1 class="jobSectionHeader"> 
Description 
 
</h1>Position Purpose :
Administers infrastructure including hardware, software, and various configurations. Provides administration and maintenance of user devices and communications links to assure operational availability. Deploys and administers routing protocols and network devices (switches, routers, firewalls, load balancers). Administers and tests networking hardware and software. Performs remedial maintenance of network devices including the restoration of hardware and software.
Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
This position is not eligible for sponsorship now or in the future.
Location:
This position is full‑time (Monday&ndash;Friday, 40 hours per week), consisting of a mandatory three days in the office Tuesday-Thursday and two days working from home Monday/Friday (please note at times there may be a business need of in office depending on workload and priority level) in Columbia, South Carolina.
To Qualify for This Position, You&rsquo;ll Need the Following :
<ul><li>Administers use, capacity and performance of network systems. Focuses on both hardware and software aspects of network operations across multiple platforms. Works with end users and vendors to resolve network hardware/software issues.
</li><li>Upgrades and configures network devices from multiple vendors. Maintains effective relationships with external suppliers to ensure appropriate levels of support. Schedules, plans, and performs system upgrades, including coordinating the transition from test to production environments.
</li><li>Confers with network users about how to solve problems affecting network performance. Validates and adjusts network configuration when needed to resolve issues. Generates network utilization/trending/error reports as requested. Observes and controls the status and performance of all components of network/system facilities.
</li><li>Maintains change control of network devices. Control access to, and authorization level of network devices. Anticipates and mitigates potential attacks through network or other connections to ensure the security of the system. Maintains effective security/backup and disaster recovery processes and systems. Performs data backups and disaster recovery operations as needed.
</li><li>Address network vulnerabilities within audit-mandated time frames. Ensure network compliance with audit requirements. Participates in continuous review and update to ensure that processes meet changing business unit conditions.
</li><li>Creates and maintains process and procedure documentation. Provides feedback on commonly encountered problems and misunderstandings to enhance user documentation and/or training programs etc. Works with others to establish and improve processes and procedures.
</li><li>Updates knowledge and skills to keep up with rapid advancements in network administration technology.
</li></ul>To Qualify for This Position, You&rsquo;ll Need the Following:
Required Education:
<ul><li>Bachelor's in a job related field
</li></ul>Degree Equivalency:
<ul><li>Associates degree plus an extra 2 years of job-related work experience for a total of 6 years of required work experience (see &quot;required work experience&quot;)
</li></ul>OR
<ul><li>8 total years required work experience. 
</li></ul> 
Required Work Experience:
<ul><li>4 years of network or other job related experience. 
</li></ul> 
Required Skills and Abilities:
<ul><li>Strong technical knowledge of networking, communications, and related hardware and software.
</li><li>Knowledge of network technologies and platforms.
</li><li>Strong technical skills including problem analysis of network systems.
</li><li>Able to gather information to troubleshoot various network problems.
</li><li>Strong organizational and interpersonal skills.
</li><li>Ability to communicate technical issues with non-technical people.
</li><li>Strong customer service skills.
</li><li>Strong knowledge of common network administration, monitoring and security utilities. 
</li></ul> 
Required Software and Other Tools:
<ul><li>Strong understanding of relevant network hardware and software.
</li><li>Strong understanding of Microsoft Office Suite from a systems support/break-fix perspective.
</li></ul>We Prefer That You Have the Following :
<ul><li>Experience with CISCO ACI.
</li><li>Experience with CISCO ISE.
</li><li>F5 BigIP Load balancing.
</li><li>Hands on Palo Alto experience.
</li><li>5 years-of experience working in infrastructure/network environments performing monitoring (hardware and/or software) and implementations.
</li><li>CCNA, CCNP, or CCVP Certified. 
</li></ul> 
Work Environment:
Fast paced, multi-platformed environment which may require action and response 24X7 to support the technical business needs of the customer.
Our comprehensive benefits package includes the following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
<ul><li>Subsidized health plans, dental and vision coverage
</li><li>401k retirement savings plan with company match
</li><li>Life Insurance
</li><li>Paid Time Off (PTO)
</li><li>On-site cafeterias and fitness centers in major locations
</li><li>Education Assistance
</li><li>Service Recognition
</li><li>National discounts to movies, theaters, zoos, theme parks and more
</li></ul>What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
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 mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 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. Here's more information .
Some states have required notifications. Here's more information .</div>

Senior Network Administrator

<div><h1 class="jobSectionHeader">Summary
 
</h1>Under general supervision, performs a variety of routine to moderately complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging items in accordance with standard procedures in one or more of the following areas; general accounting, accounts payable, accounts receivable or related financial area. May complete special projects.
<h1 class="jobSectionHeader"> 
Description 
 
</h1>Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina &hellip; and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose: This position will support the OPR Appeals Team by processing appeal effectuations accurately and efficiently. This role focuses on reviewing claim adjustments, updating accounts receivable, and issuing refunds in accordance with departmental guidelines and established timelines.
Logistics:
<ul><li>https://cgsadmin.com/ &ndash; one of BlueCross BlueShield's South Carolina subsidiary companies.
</li></ul>Location:
<ul><li>This is a full-time position (40-hours/week) working an 8hr shift Monday-Friday within the hours of 6:00am-6:00pm central time at 26 Century Blvd Suite ST610 Nashville TN 37214 in an office environment.
</li><li>Qualified internal employees may remain in their W@H location if selected.
</li></ul>SCA Benefit Requirements:
<ul><li>SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act ( SCA ). Under the McNamara-O'Hara Service Contract Act (SCA), employees are required to enroll in health insurance benefits regardless of other insurance coverage. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
</li></ul>Sponsorship :
<ul><li>This position is not eligible for sponsorship now or in the future.
</li></ul>What You'll Do:
<ul><li>Prepares various financial data associated with refunds, invoices, recoupments, adjustments, cash disbursements, deposits, check voids and reissues, disputes, correspondence, or other data in support of the finance or accounting function. Ensures data is complete, accurate, and organized for processing. Provides supervisor with daily, weekly, and/or monthly summary reports of accounting activities for the position.
</li><li>Completes moderately difficult research using financial reporting systems, files, and other means to identify errors such as overpayments or misapplication of funds. Resolves routine questions and problems, referring complex issues to higher levels.
</li><li>Performs calculations on financial documents to ensure accuracy of bank deposits, receipts, disbursements, refunds, or other accounting-related items.
</li><li>Provides other support duties related to the accounting/finance function that may include monitoring financial systems, keying journal entries, tracking funds, balancing accounts, maintaining inventory and receiving cash funds from customers, etc. May assists less experienced accounting clerks as needed.
</li><li>Determines, prepares, and distributes correspondence regarding monies due or erroneously received. Issues refunds as appropriate. 
</li></ul> 
To Qualify for This Position, You'll Need:
<ul><li>Required Education: Associate's or equivalent in a job-related field.
</li><li>Degree Equivalency: 2 years job related work experience.
</li><li>Required Software and tools : Microsoft Office to include proficiency in Excel.
</li><li>Required Skills and Abilities: Good oral and written communication. Excellent organization skills and attention to detail. Strong business math skills. Typical office environment.
</li></ul><div>Key Responsibilities:
 
<ul><li>Process appeal effectuations by reviewing claim adjustments for accuracy and completeness.
</li><li>Update account receivables and ensure all financial records are current and compliant.
</li><li>Process refunds in accordance with organizational procedures and federal guidelines.
</li><li>Utilize MCS, OnBase, and HIGLAS applications for daily workload; cross-train and support VMS processing as needed.
</li><li>Maintain thorough documentation and ensure data integrity across all systems.
</li><li>Collaborate with the Appeals Team to resolve discrepancies and support workload priorities.
</li><li>Meet productivity and quality standards while adhering to audit and compliance requirements.
</li></ul></div>Our comprehensive benefits package includes the following:
<ul><li>We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
</li><li>Subsidized health plans, dental and vision coverage
</li><li>401k retirement savings plan with company match
</li><li>Life Insurance
</li><li>Paid Time Off (PTO)
</li><li>On-site cafeterias and fitness centers in major locations
</li><li>Education Assistance
</li><li>Service Recognition
</li><li>National discounts to movies, theaters, zoos, theme parks and more.
</li></ul>What We Can Do for You:
<ul><li>We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
</li></ul>What to Expect Next:
<ul><li>After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. 
</li></ul> 
 
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 mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 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. Here's more information .
Some states have required notifications. Here's more information .</div>

Technician, Accounting II

<div><h1 class="jobSectionHeader">Summary 
 
</h1><h1 class="jobSectionHeader"> 
Description 
 
</h1>Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina &hellip; and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose: Independently investigates, evaluates, and negotiates the resolution of assigned claims within approved authority. Responsible for making recommendations for claim outcomes on claims exceeding level of authority.
Logistics: Planned Administrators Inc. (PAI) - one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This is a full-time position, with a Remote schedule ** , working an 8-hr. shift (40-hours/week) Monday-Friday 8:00am &ndash; 5:00pm with primary location at 17 Technology Circle Columbia SC, Columbia, SC 29203. ** Due to initial training period and some on-site activities, qualified, local candidates need apply.
What You'll Do:
<ul><li>Using advanced subject matter expertise; conduct investigations of assigned claims (workers comp, first and third party property, general liability or auto physical damage) in adherence with corporate timeliness and quality performance standards. Some claims may require in-person investigation/contact with an independent adjusting firm, accident reconstruction by an engineering firm and/or legal research with or without utilization of counsel.
</li><li>Manage (catastrophic, high exposure and complexity) caseload to ensure proactive disability, medical management and timely response to treatment recommendations, ongoing contact with the injured and insured, and a 100% closing ratio.
</li><li>Provide direction and possible training to less experienced adjustors on less complex cases as needed.
</li><li>Document activities, case action plans, settlements evaluations and requests for authorizations in the claim notes. Provide management and internal and external customers with documentation to support recommendations and claim status as required.
</li><li>Direct litigation process and work with attorneys to establish defense strategy and case legal budget. negotiate settlements directly with claimants or opposing counsel. May require attendance or testimony at hearings, trials, or mediations. Evaluate specials, damages, and/or extent of disability and negotiate settlements with individuals and/or attorneys.
</li><li>Utilize independent adjustors to assist in the evaluation of liability and for damages and reports findings. Reviews independent adjustor's reports and handles claim outcome.
</li></ul>To Qualify for This Position, You'll Need the Following:
<ul><li>Required Education: Bachelor's degree (see degree equivalency below)
</li><li>Degree Equivalency : 4 years job related work experience or Associate's and 2 years job related work experience.
</li><li>Required Work Experience: 4 years of area related adjusting experience.
</li><li>Required Skills and Abilities: Ability to analyze laws, regulations and contract language. Ability to evaluate issues and develop recommendations. Ability to handle confidential and sensitive information. Ability to investigate assigned claims and propose claims adjustments and refunds. Strong verbal and written communication skills. Strong interpersonal skills.
</li><li>Required Software and Other Tools : Microsoft Office.
</li><li>Required Licenses and Certificates: Valid adjuster's license in required states or ability to acquire within 6 months-if required by resident state's department of insurance.
</li></ul>We Prefer That You Have the Following:
<ul><li>Strong organizational skills.
</li><li>Solid ability and experience navigating multiple systems.
</li><li>Able to work independently.
</li><li>Able to manage distractions effectively.
</li><li>Strong communication skills, both verbally and written.
</li></ul>Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
<ul><li>Subsidized health plans, dental and vision coverage
</li><li>401k retirement savings plan with company match
</li><li>Life Insurance
</li><li>Paid Time Off (PTO)
</li><li>On-site cafeterias and fitness centers in major locations
</li><li>Education Assistance
</li><li>Service Recognition
</li><li>National discounts to movies, theaters, zoos, theme parks and more.
</li></ul>What We Can Do for You:
We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. 
What To Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
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 mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 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. Here's more information .
Some states have required notifications. Here's more information .</div>

Senior Claims Adjuster (Workers Compensation)

Overview We are seeking a dynamic and detail-oriented &lt;PHONE&gt; to join our team! In this vital role, you will serve as a key point of contact, ensuring smooth communication and efficient handling of inquiries. Your energetic approach and proactive mindset will help foster positive interactions with clients, colleagues, and stakeholders. This position offers an exciting opportunity to develop your skills in a fast-paced environment while contributing to the overall success of our organization.Responsibilities<ul><li>Manage incoming calls and direct them appropriately, ensuring prompt and courteous service</li><li>Maintain accurate records of all communications and interactions for future reference</li><li>Assist with scheduling appointments, meetings, and follow-up activities to support team operations</li><li>Collaborate with team members to streamline communication processes and improve efficiency</li><li>Provide clear information to callers and visitors, addressing inquiries or escalating issues as needed</li><li>Support administrative tasks such as data entry, document preparation, and filing systems</li><li>Contribute to a positive work environment by demonstrating professionalism and enthusiasm in every interaction</li></ul>Requirements<ul><li>Excellent verbal communication skills with a friendly and energetic demeanor</li><li>Strong organizational abilities and attention to detail</li><li>Ability to multitask effectively in a busy setting while maintaining professionalism</li><li>Proficiency in basic computer applications such as MS Office Suite (Word, Excel, Outlook)</li><li>Prior experience in customer service or administrative roles is preferred but not required</li><li>Ability to work independently as well as part of a team in a fast-paced environment</li></ul>Join us if you&rsquo;re ready to bring your energy and enthusiasm into a role that makes a real difference! We value proactive individuals who thrive on building positive relationships and supporting our organization&rsquo;s success. This paid position offers an engaging work environment where your contributions are recognized and appreciated.Job Type: Full-timePay: $25.00 - $59.77 per hourWork Location: In person

12132313131

<div><h1 class="jobSectionHeader">Summary 
 
</h1><h1 class="jobSectionHeader"> 
Description 
 
</h1>Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we&rsquo;ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina &hellip; and much more. We are one of the nation&rsquo;s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose: Complete Accounts Payable function including posting vouchers, check posting and coordination of payments with vendors. Obtain approvals for invoices through multiple managers, including managing the AP emails for approvals. Process EFT and check payments, including directing all debits/credits transfer to Wells Fargo, Corporate Treasury, and Misc Funding. Send notices to vendors after the advice is created. Complete monthly close journal entries associated with AP or accruals. Manage the P-card process by booking hotels, ordering items or otherwise processing payments using the company card. Reconcile the credit card statement for all of the corporate cards for CGS.
Logistics: CGS (cgsadmin.com) , one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This is a full-time position (40-hours/week) working an 8hr shift Monday-Friday within the hours of 6:00am-6:00pm central time at 26 Century Blvd Suite ST610 Nashville TN 37214 in an office environment. Hybrid/remote opportunities may be available after initial training period.
SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act ( SCA ). Under the McNamara-O'Hara Service Contract Act (SCA), employees are required to enroll in health insurance benefits regardless of other insurance coverage. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
What You&rsquo;ll Do:
<ul><li>Prepares various in-depth financial data associated with refunds, invoices, recoupments, adjustments, cash disbursements, deposits, check voids and reissues, disputes, correspondence, or other data in support of the finance or accounting function. Ensures data is complete, accurate, and organized for processing. Provides supervisor with daily, weekly, and/or monthly summary reports of accounting activities for the position.
</li><li>Completes moderately difficult to complex research using financial reporting systems, files, and other means to identify errors such as overpayments or misapplication of funds. Resolves most questions and problems, referring most complex issues to higher levels.
</li><li>Performs calculations on financial documents to ensure accuracy of bank deposits, receipts, disbursements, refunds, or other accounting-related items.
</li><li>Provides other support duties related to the accounting/finance function that may include monitoring financial systems, tracking funds, balancing accounts, maintaining inventory and receiving cash funds from customers, etc. Assists less experienced accounting clerks as needed.
</li><li>Prepares journal entries and account reconciliations. Responds to telephone and written inquiries from internal and external customers to ensure accurate billing, payments and/or collections.
</li></ul>To Qualify, You&rsquo;ll Need:
<ul><li>Required Education: Bachelor's in a job-related field
</li><li>Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience
</li><li>Required Skills and Abilities: Good oral and written communication and customer service skills. Excellent organization skills and attention to detail. Strong business math skills.
</li><li>Required Software and Tools: Microsoft Office.
</li></ul>We Prefer That You Have:
<ul><li>Strong MS Office skills, and especially with Excel.
</li><li>Keen attention to detail.
</li></ul>Our comprehensive benefits package includes the following:
<ul><li>We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
</li><li>Subsidized health plans, dental and vision coverage
</li><li>401k retirement savings plan with company match
</li><li>Life Insurance
</li><li>Paid Time Off (PTO)
</li><li>On-site cafeterias and fitness centers in major locations
</li><li>Education Assistance
</li><li>Service Recognition
</li><li>National discounts to movies, theaters, zoos, theme parks and more.
</li></ul>What We Can Do for You:
<ul><li>We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.
</li></ul>What to Expect Next:
<ul><li>After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
</li></ul>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 mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 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. Here's more information .
Some states have required notifications. Here's more information .</div>

Accounting Technician III (Accounts Payable)

Join Blue Cross Blue Shield and explore 7   exciting career opportunities. They're hiring for various roles with options for remote or on-site work. Apply today and become part of their innovative team.