Specialist, Provider File I

About This Role

This role is responsible for establishing and maintaining healthcare provider files, supporting accurate claims adjudication and provider billing within the BlueCross BlueShield of South Carolina network. This position ensures the integrity of provider data for directories and internal systems.

Responsibilities

• Verify necessary information and establish certification of healthcare service providers
• Prepare and maintain provider files and data (updates, additions, deletions) on the provider information management system (PIMS) or other provider systems
• Identify and assign providers to the appropriate network and system/database
• Contribute to the department's production standard by working on PIMS and AMMS maintenance and error reports
• Contribute to and participate in special projects, such as mass rate updates, quality improvement, and audits

Requirements

• High School Diploma or equivalent
• 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience
• Working knowledge of word processing and spreadsheet software (Microsoft Office)
• Knowledge/understanding of or ability to acquire PIMS
• Good judgment skills
• Effective customer service and organizational skills
• Demonstrated verbal and written communication skills
• Basic business math proficiency
• Ability to handle confidential or sensitive information with discretion

Qualifications

• High School Diploma or equivalent
• 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.

Nice to Have

• Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes
• Excellent telephone skills
• Previous Customer Service experience

Skills

* Required skills

Benefits