Specialist, Provider File I jobs in United States
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Facebook · 4 hours ago

Specialist, Provider File I

BlueCross BlueShield of South Carolina is a leading insurance company with deep roots in the community, and they are seeking a Specialist, Provider File I. This role is responsible for maintaining healthcare provider files to support accurate claims adjudication and provider billing.

Computer Software
badNo H1BnoteSecurity Clearance RequirednoteU.S. Citizen Onlynote

Responsibilities

Verifies necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or establishes certification of healthcare service providers. Prepares provider files/maintains provider data (updates, additions, deletions) on the provider information management system (PIMS) or appropriate provider system/database
Identifies/assigns providers to the appropriate network and provider system/database
Contributes to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports
Contributes to and participates on special projects, which may include but are not limited to the following: mass rate updates, quality improvement, audits, etc

Qualification

PIMS knowledgeClaims processingCustomer serviceMicrosoft OfficeDB2SQL languageJudgmentBusiness math proficiencyTelephone skillsOrganizational skillsVerbal communicationWritten communicationConfidentiality

Required

High School Diploma or equivalent
1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience
Working knowledge of word processing and spreadsheet software
Knowledge/understanding of or ability to acquire PIMS
Good judgment skills
Effective customer service and organizational skills
Demonstrated verbal and written communication skills
Basic business math proficiency
Ability to handle confidential or sensitive information with discretion
Microsoft Office

Preferred

Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes
Excellent telephone skills and previous Customer Service experience

Benefits

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

Company

Facebook

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The Facebook company is now Meta. Meta builds technologies that help people connect, find communities, and grow businesses.

Funding

Current Stage
Late Stage

Leadership Team

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Arunava Chatterjee
Executive Director of Ghost Black Operations & CEO & CTO
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Shubhra Gupta
CEO
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Company data provided by crunchbase