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 … 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: Responsible for the management of assigned claims operation(s) to ensure that investigation and adjudication of claims meet established performance standards and objectives. Position may be assigned to multiple lines of business, contracts, and specialty claims operations.
Logistics: Planned Administrators Inc. (PAI) - one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This is a full-time position, with a Hybrid schedule**, working an 8-hr. shift (40-hours/week) Monday-Friday 8:00am – 4:30pm with primary location at 17 Technology Circle Columbia SC, Columbia, SC 29203. **Due to the hybrid nature of the schedule, qualified, local candidates need apply.
Sponsorship: This position is not eligible for sponsorship, now or in the future.
What You'll Do:
Provides management and oversight of claims to ensure performance standards are maintained including investigation and adjudication of claims, file documentation and management, reserving practices, pursuit of recovery and other account specific or contractual requirements.
Develops and maintains effective working relationships with external business partners to include insureds, agents, self-insured clients, vendors, defense firms, and other business partners for assigned lines of business, contracts or specialty claims operations. Responsible for development and maintaining effective working relationships with other operational and support areas.
Responsible for development of claims staff, vendors, and contractors to ensure quality claims handling and outcomes. May include identification of training needs, implementation of educational programs, process changes, performance management, and audit functions.
Completes requests for proposal, bids, and due diligence efforts on potential new jurisdictions, contracts, or specialty claims programs. Responsible for effective implementation and management of new business opportunities.
Assists claims senior management team in achieving both departmental and corporate strategies and goals.
To Qualify for This Position, You'll Need the Following:
Required Education: Bachelor's degree (see degree equivalency below)
Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.
Required Work Experience: 2 years of area related adjusting experience.
Required Training: Valid adjustor's license in required states or ability to acquire within 6 months-if required by the resident state's department of insurance.
Skills and Abilities: Analyzes laws, regulations and contract language. Evaluates issues and develops recommendations. Handles confidential and sensitive information. Investigates assigned claims. Proposes claims adjustments and refunds. Works claims caseloads.
We Prefer That You Have the Following:
Preferred Experience: Prior management experience directly related to position assignment (i.e. WC, Liability, TPA, or specialty operations).
Preferred Skills and Abilities: Strong decision-making skills and an ability to work independently with limited direction while leading others.
Preferred Software and Other Tools: Microsoft Office; Ability to manage various Claims Operating Systems.
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.
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.
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.
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