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Provider File Specialist I jobs in United States
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Facebook · 14 hours ago

Provider File Specialist I

BlueCross BlueShield of South Carolina is a leading insurance company with a long-standing presence in the community. The Provider File Specialist I is responsible for establishing and maintaining healthcare provider files to support provider directories and claims adjudication.
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

Microsoft OfficePIMS knowledgeDB2SQLMicrosoft ExcelCustomer serviceResearch skillsOrganizational skillsVerbal communicationWritten communication

Required

High School Diploma or equivalent
1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience
Microsoft Office
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

Preferred

Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes
Proficiency in Microsoft Excel (data entry, spreadsheets, basic formulas, reporting)
Experience using Microsoft Outlook for email management and scheduling
Self‑motivated, able to work independently and manage time effectively
Strong research skills with the ability to gather, analyze, and summarize information

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