BlueCross BlueShield of South Carolina Benefits Overview

Manages a provider enrollment unit, overseeing accurate and timely provider enrollment, claims administration, regulatory compliance, staff performance, quality assurance, fraud awareness, reporting, and process improvements. The role supervises enrollment and analyst staff, monitors productivity and quality standards, analyzes trends, coordinates with internal departments, and ensures adherence to applicable laws and requirements.

Performs institutional provider audits to verify billing accuracy, identify aberrant or fraudulent billing, review claims and medical records, communicate findings to providers and claims operations, document cost savings, recover overpayments, and conduct onsite audits across South Carolina.

Performs entry-level accounting activities, including account reconciliations, general ledger and journal entries, spreadsheet preparation, financial reporting, budgeting and forecasting analysis, and maintenance of accurate G/L accounts. Assists with regulatory filings, special projects, process controls, and coordination across departments. Requires knowledge of fundamental accounting concepts, analytical and organizational skills, discretion with sensitive information, and proficiency with Microsoft Office and data retrieval applications.