BlueCross BlueShield of South Carolina

Director, Ancillary Sales & Marketing Representative

BlueCross BlueShield of South Carolina · Full Time · 7 hours ago

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 5-10 yrs exp 💼 Sales

The Director leads corporate distribution systems, general agents, and brokers to drive product marketing, sales, and profitability across multiple states. They are responsible for developing sales themes, managing renewal processes, and implementing policies to enhance service standards and production.

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Senior Medical Reviewer (Behavioral Health Focused)

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

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Senior Medical Reviewer acts as a team lead for specialty programs, providing guidance, training, and direction to staff to ensure appropriate healthcare service levels. They monitor workflows, participate in quality reviews, and resolve discrepancies while maintaining compliance with departmental standards.

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Analyst, Appeals

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

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Others

The analyst researches complex appeal and retrospective review requests to determine medical necessity based on clinical guidelines. They document decisions accurately while ensuring compliance with regulatory standards and confidentiality requirements.

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Physical Medicine and Rehabilitation Medical Director

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

BlueCross BlueShield of South Carolina

🌎 Canada, France, Trinidad and Tobago, United Kingdom, United States 💵 $206K - $413K per year ⭐ 5-10 yrs exp 💼 Healthcare

The Medical Director provides administrative oversight to medical staff, analyzes utilization data, and develops claim adjudication criteria. They also act as a liaison between the company and the medical community while researching new medical procedures and technologies.

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Physical Medicine and Rehabilitation Medical Director

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

BlueCross BlueShield of South Carolina

🌎 Canada, France, Trinidad and Tobago, United Kingdom, United States 💵 $206K - $413K per year ⭐ 5-10 yrs exp 💼 Healthcare

The Medical Director provides administrative oversight to medical staff, analyzes utilization data, and develops claim adjudication criteria. They also act as a liaison between the company and the medical community while researching new medical procedures and policies.

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Payment Integrity Nurse – Medicare Advantage

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

BlueCross BlueShield of South Carolina

🌎 United States ⭐ 2-5 yrs exp 💼 Healthcare

The Payment Integrity Nurse monitors quality improvement activities, conducts medical record reviews, and ensures compliance with regulatory standards. They also coordinate HEDIS data collection and recommend corrective actions to maintain quality of care.

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Sr Stoploss Claim Auditor-2

BlueCross BlueShield of South Carolina · Full Time · 7 days ago

BlueCross BlueShield of South Carolina

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

The auditor is responsible for analyzing and authorizing medical stop loss claims while identifying cost mitigation and subrogation opportunities. They also manage claims investigations, maintain system reports, and provide support through training and internal auditing.

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Accounting Technician III

BlueCross BlueShield of South Carolina · Full Time · 10 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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