Jobs at BlueCross BlueShield of South Carolina

Manage daily service and administrative operations for large group market, lead and develop staff, oversee sales and retention programs, monitor marketplace trends, implement product and marketing plans, train personnel, ensure quality and process improvements, and maintain customer service standards.

Provide telephonic care management and coordination including assessment, planning, monitoring, authorization review, member education, advocacy, referrals, documentation of medical necessity, and collaboration with providers to improve outcomes and manage costs.

The Senior Proposal Specialist develops high-quality proposals for strategic RFPs and RFIs, coordinating with sales and SMEs while managing proposal processes and crafting compelling narratives.

Audit and adjudicate medical stop loss claims, authorize reimbursements within limits, and identify cost-mitigation and subrogation opportunities. Initiate investigations and vendor referrals, interpret plan language, communicate with carriers and vendors, generate claims reports, adjust reserves, and assist with form development, internal auditing, and training of claims auditors.

Acts as primary day-to-day contact for assigned clients, resolves service issues, supports client implementations and training, ensures accuracy of client/member materials, and coordinates with internal teams to meet client needs.

Lead Institutional Provider contracting operations, set strategy, ensure contract performance, manage budgets and actuarial coordination, direct staff development, and negotiate managed care contracts with deep hospital reimbursement expertise.

Support the sales team by managing RFPs, client references, and partner relationships; improve sales processes; develop presentations and materials; gather market and competitive intelligence; and coordinate cross-functional execution to ensure timely, high-quality sales outcomes.

Direct and guide appeals, customer service, and claims processing teams across operational areas. Track performance, implement process improvements, lead system enhancement projects, manage budgets and staffing, and support departmental strategic objectives to improve provider and customer satisfaction.

Coordinate and perform testing for system enhancements: create/review test matrices, execute test cases, document and research system issues, liaise between production operations and IT, and prepare reports with recommendations.

Lead and manage client implementations and renewals, coordinate internal/external stakeholders, document processes, track deliverables and timelines, communicate progress, triage membership/eligibility escalations, and ensure quality of design, testing, training, and operations documentation.

Support the Retail Manager by driving retail and outside sales of health insurance products, coaching and mentoring staff, executing local marketing and community events, tracking retail performance, handling escalations, and serving as manager backup while maintaining required insurance licensure.

The Accountant III-CDS reconciles general ledger accounts, processes complex transactions, ensures compliance with regulations, and trains junior accountants at BlueCross BlueShield of South Carolina.

Process and research insurance claims accurately and timely, verify procedure and diagnosis coding, resolve system edits and audits, coordinate with internal departments to update patient, provider, and insurance records according to company guidelines.

Verify, prepare, review, and maintain healthcare provider files and data in PIMS/AMMS to support provider directories, accurate claims adjudication, and provider billing. Assign providers to networks, contribute to production standards and error reports, and participate in special projects and quality audits.

Conduct market, product, and competitor research; complete and manage RFPs/RFIs for multiple divisions; develop and maintain proposal databases; collect and analyze market and proposal data; prepare reports and forecasts; provide management recommendations and coordinate information across functional areas.

Accurately and promptly process healthcare claims: verify procedure and diagnosis codes, research and resolve system edits/audits/claim errors, and coordinate with internal departments to update patient, provider, and insurance records.

Support MAR/SOX compliance through risk assessments, control testing, documentation, reporting deficiencies, preparing audit reports, peer review, and coordinating remediation with management and regulators.

Lead and grow reinsurance and provider excess-loss business by building broker and health-plan relationships, overseeing underwriting and sales, setting metrics and financial goals, ensuring compliance, developing marketing strategies, managing budgets, and maintaining high broker/agent satisfaction and product competitiveness.

Responsible for accurate and timely processing of claims, coordinating with internal departments, and verifying coding of procedures and diagnoses.

Responsible for identifying training needs, developing materials, and facilitating training. Provides guidance and leadership for new specialists and evaluates training effectiveness.