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Provides reinsurance support for new and renewal business, underwriting, claims audit/record keeping and/or other functions. May perform calculations and process general accounting requests for billing or payments, and/or check the status of claims and process policy changes. Provides customer service to clients and partners. Runs reports as needed. This position is located onsite. Description 5
Posted 15 days ago
BlueCross BlueShield of South Carolina
- Springfield, IL / Columbia, SC / Charleston, SC / 1 more...
Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. Reviews assigned portions of audit programs, determines compliance with policies and procedures, recommends corrective action plan
Posted 9 days ago
We are seeking a motivated Federal Business Development and Capture Manager to provide the full cycles sales process regarding new business development in the federal health care marketspace. Manages all activities of proposal development. Responsible for searching out, understanding, verbally articulating detailed analysis of RFPS, RFIS, RFQS, and other documents. Collaborates with management, Su
Posted 12 days ago
Oversees the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identifies and implements process improvement opportunities. Description 70% Manages the medical review process. Maintains a well trained staff. Develops/implements medical review strategy wit
Posted 18 days ago
Provides education to medical providers as warranted. Description 25% Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts. Documents all provider contacts/communications in provider tracking system. 20% Conducts formal conference calls and/or in person
Posted 14 days ago
Responsible for the management and daily operations of the technical staff responsible for devising logical, automated statistical analysis programs and procedures. Description 30% Manages the activities of research and analysis staff responsible for complex statistical analysis programming and sophisticated data interpretation to support customer requirements. 20% Maintains effective communicat
Posted 15 days ago
Negotiates Pharmacy Benefit Management (PBM) contract terms with Commercial Business self funded groups for retail/mail order/specialty pharmacy service and specialty drug medical management rebate sharing services. Monitors contract performance including performance guarantees, financial guarantees, and compliance with state and federal regulatory requirements specific to self funded groups. Nego
Posted 7 days ago
Provides prompt, accurate, thorough and courteous responses to all telephone inquiries. Performs research as needed to resolve inquiries. Description Ensures effective customer relations by responding accurately, timely and courteously to telephone inquiries. Accurately documents inquiries. Initiates minor /clerical adjustments based on provider request or processes adjustments or performs other
Posted 22 days ago
Provides care management services to more than 2 million members in South Carolina and nationally. Administers complex, high touch concierge case management for members identified into specialized programs such as high risk maternity, NICU, ESRD, Palliative Care Behavioral Health. Identifies risks and provides outreach services to facilitate the coordination of healthcare services and gap closure.
Posted 23 days ago
Provides reinsurance support for new and renewal business, underwriting, claims audit/record keeping and/or other functions. May perform calculations and process general accounting requests for billing or payments, and/or check the status of claims and process policy changes. Provides customer service to clients and partners. Runs reports as needed. Description 55% Processes mail, email and faxe
Posted 29 days ago
Directs development and maintenance of provider network. Provides guidance and direction over staff responsible for any or all of the following areas within the network provider relations, provider contracting, recruitment, fee negotiations, customer services, credentialing, and database management Description 60% Develops and maintains provider network. Directs and oversees activities and staff
Posted 9 days ago
Responsible for identifying training needs, developing training materials and facilitating training. Provides training, guidance and leadership for new training specialists. Develops performance assessments and testing materials. Manages trainees and communicates effectively with area management on trainee performance. Description 50% Leads, plans and prioritizes training projects from conductin
Posted 9 days ago
Responsible for moderately complex accounting activities relating to the maintenance of a complete and accurate general ledger and/or the resultant managerial reports and/or financial statements. Description 30% Reconciles assigned general ledger accounts of routine to moderate complexity. Initiates and/or processes journal entries into various accounts. Performs reviews of various systems activ
Posted 9 days ago
Consults with lines of business leadership, retail and marketing staff, etc. to offer guidance on editorial content and ad direction. Works closely with media relations staff to amplify corporate news and augment traditional media channels. Manages customer service issues that surface via social media and works with HR on recruitment messaging, and with customer experience to ensure that efforts a
Posted 12 days ago
Description 30% Prepares daily and/or monthly account reconciliations of a complex nature. Ensures work conforms to all contract/business regulations and/or instructions as well as generally accepted accounting principles, federal acquisition regulations, cost accounting standards and/or departmental policies. 30% Reviews, analyzes, and/or verifies complex accounting and/or system transactions. I
Posted 13 days ago
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