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BlueCross BlueShield of South Carolina logo
BlueCross BlueShield of South Carolina

South Carolina’s largest and oldest health insurance company

Claims Technician

Claims SpecialistClaims SpecialistFull TimeRemoteMid LevelTeam 10,001+Since 1946H1B No SponsorCompany SiteLinkedIn

Location

United States

Posted

74 days ago

Salary

0

Seniority

Mid Level

No structured requirement data.

Job Description

Claims Technician

BlueCross BlueShield of South Carolina

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, distributing mail, screening, scanning, data element verification and document indexing. Applies knowledge of department policies and procedures and utilizes a general understanding of other departments' functions. Maintains records, prepares forms, verifies information and resolves routine problems. Ensures claims are processed in a timely manner. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am-5:00pm in a typical office environment. This role is located on-site at 200 N Dozier Blvd, Florence, SC 29501. After successfully completing training, this position may transition to a fully remote work schedule based on performance and business needs. - Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. - 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 cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. What You’ll Do: - Receives, opens, sorts and distributes incoming departmental mail or work requests. Checks workflow documents to ensure required information is available. Requests any missing documentation as needed. Scans all documents for storage in the electronic repository. Prepares correspondence or packages for internal/external mailing. - Screens and verifies information. Ensures proper and accurate processing flow of all paper claims and correspondence in accordance with department standards for quality and production, contract regulations, policies and guidelines. - Conducts data element verification of data elements for those that fail the mapping process prior to claims adjudication. Applies appropriate indexes as needed to claims and/or correspondence. - Maintains departmental logs, spreadsheets or databases. Effectively uses all available reference materials in performance of daily functions. - Keeps track of supply inventory and/or orders supplies as needed. To Qualify for This Position, You'll Need the Following: - Required Education: High School Diploma or equivalent - Required Skills and Abilities: - Strong organizational and analytical skills. - Good communication and organizational skills. - Detail-oriented. - Ability to handle confidential or sensitive information with discretion. We Prefer That You Have the Following: - Preferred Skills and Abilities: - Ability to accurately key 5000 ksph or 30 wpm. - Knowledgeable in word processing and spreadsheet applications. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for 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. Some states have required notifications. Here's more information.

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Vantage Risk Companies logo

Senior Claims Specialist, Cyber Claims

Vantage Risk Companies

Vantage Group Holdings Ltd. (Vantage) was established in late 2020 as a re/insurance partner designed for the future. Driven by relentless curiosity, our team of trusted experts provides a fresh perspective on our clients’ risks. We add creativity to tech-enabled efficiency and robust analytics to address risks others avoid. Vantage provides specialty re/insurance through its operating subsidiaries in Bermuda and the U.S. Approximately 365 colleagues in both the United States and Bermuda. Offices in Chicago, IL, Norwalk, CT, Arlington, VA, Boston, MA, New York, NY, Atlanta, GA and Hamilton, Bermuda. Highly geographically diverse workforce with colleagues based in 35 states and counting. Fully support work flexibility including remote and hybrid work arrangements.

Full TimeRemoteTeam 201-500

About the Company Vantage Group Holdings Ltd. (Vantage) was established in late 2020 as a re/insurance partner designed for the future. Driven by relentless curiosity, our team of trusted experts provides a fresh perspective on our clients’ risks. We add creativity to tech-enabled efficiency and robust analytics to address risks others avoid. Vantage provides specialty re/insurance through its operating subsidiaries in Bermuda and the U.S. Vantage has approximately 365 colleagues in both the United States and Bermuda. We have offices in Chicago, IL, Norwalk, CT, Arlington, VA, Boston, MA, New York, NY, Atlanta, GA and Hamilton, Bermuda. Additionally, we are a highly geographically diverse workforce with colleagues based in 35 states and counting. We fully support work flexibility including remote and hybrid work arrangements. About the role: At Vantage, the Senior Claims Specialist, Cyber Claims will be a critical member of our Cyber team. The mission of the team is to add creativity to tech-enabled efficiency and robust analytics to address risks others avoid. This role will provide complete claim management and loss mitigation services for policyholders on a dedicated account basis. This role independently investigates, evaluates, and manages the disposition of Cyber claims of varying degrees of complexity and severity across multiple product types and markets. Additionally, the role supports the Underwriting Business Unit by liaising with account and broker/agent representatives, providing frequent, in-depth exposure analysis to senior leadership, and participating in marketing efforts at industry events and conferences. The ideal candidate for this position possesses knowledge and fluency in handling of Cyber claims. This role reports to the VP, Head of Cyber Claims, and is a remote work opportunity. The base salary expectation for this role is up to $115,000 - $175,000. The actual base salary and title for the selected candidate may be higher, commensurate with the candidate's experience and expectations. Additionally, Vantage offers its colleagues performance-based bonus potential, strong health & welfare benefits, retirement plans with company match, competitive time off plans, a highly flexible work environment, and much more. Responsibilities & Accountabilities: - Evaluates, reserves, and manages Cyber claims to resolution, including oversight of all phases of litigation related to Cyber exposures. - Reviews and analyzes loss notices for coverage, drafts coverage letters, and communicates coverage positions to insureds, brokers, and agents as necessary. - Communicates regularly with insureds, brokers, and internal and external stakeholders regarding individual claim development and strategy. - Provides superior customer service to, and proactively builds strong relationships with, all appropriate representatives of assigned accounts, including their internal leadership, brokers, and agents to maximize the competitive advantage derived from the Vantage Claims value proposition. - Implements Vantage Claims Best Practices for proper and consistent claim handling performance, compliance, and achievement of business goals and drives efficient and proactive litigation defense strategies by effectively managing retained counsel. - Thoroughly, clearly, and thoughtfully documents claim files with all relevant factual and evaluative information in compliance with company policies, best practices, and applicable regulatory authority where necessary. - Demonstrates superior subject matter knowledge and negotiation skills to affect appropriate claim outcomes through direct negotiation and utilizing alternative dispute resolution as necessary. - Proactively drives claim development and seeks creative ways to achieve optimal results on every file. - Implements Vantage reserving and reporting protocols to avoid unexpected developments and outcomes. - Identifies issues and trends within their accounts and the Cyber market and regularly communicates those to insureds, brokers, Vantage Claims leadership, Underwriting partners, and actuaries. - Follows all escalation and reporting protocols as required under appropriate circumstances for cases with significant potential exposure. - Attends marketing, account renewal, and reinsurance meetings as appropriate to communicate the Vantage claims handling philosophy and value proposition. - Treats all internal and external stakeholders and business partners respectfully and always demonstrates a positive attitude and collegial approach to their work. - Some travel is associated with this role (including but not limited to off-site meetings, court proceedings, mediations). 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United States
$115K - $175K / year
CorVel Corporation logo

Claims Specialist

CorVel Corporation

Raising the bar for care. Lowering risk for clients.

Full TimeRemoteTeam 1,001-5,000Since 1987H1B Sponsor

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Encova Insurance logo

Medical Only Claims Specialist, Workers' Compensation

Encova Insurance

Encova Insurance provides commercial, auto and home insurance.

Full TimeRemoteTeam 1,001-5,000H1B No Sponsor

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United States
$49.2K - $78.8K / year
Liberty Mutual logo

Associate Claims Specialist

Liberty Mutual

Liberty Mutual is a leading global insurance corporation and one of the largest casualty and property insurance companies in the nation. In the past, Liberty Mu

Role Description Ready to grow your career in a role that makes a meaningful impact? Liberty Mutual is hiring Workers' Compensation Claims Specialists in our Northeast Region to help injured workers navigate the claims process and return to work with confidence. We’re hiring across multiple levels—Associate Claims Specialist, Claims Specialist I, and Claims Specialist II—depending on your experience. The salary range posted reflects the varying pay scale across various locations. In this role, you’ll manage a caseload of routine to moderately complex claims, making key decisions on compensability, evaluating losses, and negotiating fair outcomes. You’ll collaborate closely with claimants, policyholders, attorneys, and partners throughout the claim lifecycle. Training is a critical component of your success, and that success starts with reliable attendance and active engagement. Training will include 1 week of travel to our Plano, TX office in July. This role is remote within the Northeast region. Candidates must reside in Connecticut, Delaware, Maine, Massachusetts, New Hampshire, New Jersey, New York, Pennsylvania, Rhode Island, or Vermont. Candidates residing within 50 miles of our offices in Weatogue, Connecticut, or Westborough, Massachusetts, will be expected to work onsite up to two days per month. On-site expectations may evolve based on business needs. Responsibilities - Manages an inventory of claims to evaluate compensability/liability. - Establishes action plans based on case facts, best practices, protocols, regulatory issues, and available resources. - Plans and conducts investigations of claims to confirm coverage and to determine liability, compensability, and damages. - Assesses policy coverage for submitted claims and notifies the insured of any issues; determines and establishes reserve requirements, adjusting reserves as necessary, during the processing of the claims, and refers claims to the subrogation group or Special Investigations Unit as appropriate. - Assesses actual damages associated with claims and conducts negotiations, within assigned authority limits, to settle claims. - Performs other duties as assigned. Qualifications - Effective interpersonal, analytical and negotiation abilities required. - Ability to provide information in a clear, concise manner with an appropriate level of detail. - Demonstrated ability to build and maintain effective relationships. - Demonstrated success in a professional environment; success in a customer service/retail environment preferred. - Effective analytical skills to gather information, analyze facts, and draw conclusions; as normally acquired through a bachelor's degree or equivalent. - Knowledge of legal liability, insurance coverage and medical terminology helpful, but not mandatory. - Licensing may be required in some states. Benefits - Comprehensive benefits. - Workplace flexibility. - Professional development opportunities. - Opportunities provided through Employee Resource Groups. Company Description At Liberty Mutual, our goal is to create a workplace where everyone feels valued, supported, and can thrive. We build an environment that welcomes a wide range of perspectives and experiences, with inclusion embedded in every aspect of our culture and reflected in everyday interactions. We value your hard work, integrity and commitment to make things better, and we put people first by offering you benefits that support your life and well-being.

United States
Job Closed