BlueCross BlueShield of South Carolina

Behavioral Health Case Manager II

BlueCross BlueShield of South Carolina · Full Time · a day ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

The Behavioral Health Case Manager II reviews and evaluates medical or behavioral eligibility for benefits and clinical criteria, applying clinical expertise to service requests. They provide care management, assess service needs, and ensure accurate documentation to support medical necessity criteria.

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Automation Specialist

BlueCross BlueShield of South Carolina · Full Time · 2 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The Automation Specialist identifies and implements process improvements and automation solutions to enhance operational efficiency within the Audit Reimbursement Department. This includes evaluating workflows, developing test plans, and collaborating with stakeholders to reduce manual effort and improve accuracy.

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Chronic Disease Coach - Registered Nurse (W@H SC, NC, or GA)

BlueCross BlueShield of South Carolina · Full Time · 2 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Provide personalized guidance, education, and support to members for chronic disease prevention and healthy promotion. Collaborate with members to set health goals, navigate healthcare systems, and implement action plans using motivational interviewing techniques.

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Appeals Specialist (CGS Admin)

BlueCross BlueShield of South Carolina · Full Time · 3 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Perform non-medical reviews and process redetermination letters while ensuring timeliness and accuracy. Prepare unit reports, analyze workloads, and update departmental documentation using various software tools.

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RN Case Management Coordinator

BlueCross BlueShield of South Carolina · Full Time · 5 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

The coordinator provides active care management by assessing service needs, developing action plans, and monitoring outcomes to improve client safety and quality of life. They perform medical and behavioral reviews to ensure coverage within benefit guidelines and advocate for members through education and coordination.

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Sr Stoploss Claim Auditor-2

BlueCross BlueShield of South Carolina · Full Time · 8 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $51107 - $97729 per year ⭐ 5-10 yrs exp 💼 Finance

Analyze and adjudicate medical stop loss claims to authorize reimbursements and mitigate costs. Manage claims investigations, maintain system reports, and provide training and internal auditing for other claims auditors.

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Account Specialist

BlueCross BlueShield of South Carolina · Full Time · 8 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Others

Serves as a team lead responsible for coordinating account administration processes, including enrollment, renewals, and billing for private business groups. Coordinates with cross-functional departments to ensure accurate group structures and prepares necessary contracts and benefit books.

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Medicare Cost Reporting Auditor II

BlueCross BlueShield of South Carolina · Full Time · 10 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $51107 - $97729 per year ⭐ 2-5 yrs exp 💼 Finance

Conducts a full range of Medicare financial compliance, operational, and internal control audits to identify business risks and fraud. Drafts detailed audit reports and recommendations for executive management to improve corporate processes and ensure regulatory compliance.

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Medicare Cost Reporting Auditor III

BlueCross BlueShield of South Carolina · Full Time · 10 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $57790 - $110K per year ⭐ 5-10 yrs exp 💼 Finance

Conducts comprehensive financial, compliance, and operational audits to evaluate internal controls and identify business risks. Prepares detailed audit reports and recommendations for executive management to improve corporate processes and prevent fraud.

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RN Appeals Analyst Medicare Part B - CGS

BlueCross BlueShield of South Carolina · Full Time · 12 days ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

Research and analyze complex appeal or retrospective review requests to determine if services meet medical necessity guidelines. Document decisions accurately and timely in compliance with applicable regulations and standards.

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Auditor III

BlueCross BlueShield of South Carolina · Full Time · 15 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $57790 - $110K per year ⭐ 5-10 yrs exp 💼 Finance

Conducts comprehensive financial, compliance, and operational audits to evaluate internal controls and identify business risks. Prepares detailed audit reports and recommendations for executive management to improve corporate processes and prevent fraud.

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Medicare Cost Reporting Auditor II

BlueCross BlueShield of South Carolina · Full Time · 15 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $49447 - $94737 per year ⭐ 2-5 yrs exp 💼 Finance

Conduct internal and external financial, compliance, and operational audits to evaluate internal controls and identify business risks. Draft detailed audit reports and recommendations for executive management to improve processes and prevent fraud.

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Sr Stoploss Claim Auditor-1

BlueCross BlueShield of South Carolina · Full Time · 15 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $51107 - $97729 per year ⭐ 5-10 yrs exp 💼 Finance

Analyze and adjudicate medical stop loss claims to authorize reimbursements and identify cost mitigation opportunities. Maintain claims system reports and provide training and internal auditing for other claims auditors.

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Auditor II (Medicare Cost Reporting)

BlueCross BlueShield of South Carolina · Full Time · 22 days ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $49447 - $94737 per year ⭐ 2-5 yrs exp 💼 Finance

Conducts a full range of financial, compliance, and operational audits to evaluate internal controls and identify business risks. Drafts detailed audit reports and recommendations for executive management to improve corporate processes and prevent fraud.

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Medicare Cost Report Auditor III

BlueCross BlueShield of South Carolina · Full Time · a month ago

BlueCross BlueShield of South Carolina

🌎 United States 💵 $57790 - $110K per year ⭐ 5-10 yrs exp 💼 Finance

Conduct comprehensive financial, compliance, and operational audits to evaluate internal controls and identify business risks. Prepare detailed audit reports and recommendations for executive management to improve corporate processes and ensure regulatory compliance.

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Chief Medical Officer (Medicare Policy)

BlueCross BlueShield of South Carolina · Full Time · a month ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Healthcare

Provides administrative oversight to medical staff and leads the generation and revision of medical policies. Analyzes utilization data and conducts research on new medical procedures to guide operational policies and claim adjudication.

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Accounting Technician III

BlueCross BlueShield of South Carolina · Full Time · 9 months ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Finance

Under general supervision, the Accounting Technician III performs a variety of routine to complex clerical and accounting functions. Responsibilities include inventory balancing, reconciliations, processing disbursements and deposits, and generating refund request letters.

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