Jobs at BlueCross BlueShield of South Carolina

Manage multiple IT projects, ensuring timely delivery within budget. Oversee resource allocation, project documentation, and stakeholder communication while adhering to project management methodologies.

Perform financial, compliance, and operational audits to evaluate internal controls and adherence to policies. Test transactions, interview personnel, analyze records, document findings, recommend corrective actions, and prepare audit reports. Assist other auditors and conduct special studies to detect fraud. Travel between office buildings; occasional out-of-town travel possible.

Serve as day-to-day client account lead for assigned accounts: resolve client issues and escalations, coordinate internal teams for implementations, assess and code client benefits, monitor deliverables, train clients on e-billing, and ensure accuracy of member-facing materials.

Monitor and implement quality improvement and management activities, conduct medical record reviews, analyze findings and recommend corrective actions, coordinate HEDIS data collection, support NCQA accreditation activities, and prepare compliance documentation. Collaborate with stakeholders and report quality trends and issues.

Lead small-to-medium IT projects from inception through implementation, managing scope, schedule, budget, risks, resources, communications, and documentation. Ensure adherence to project management methodologies, audit standards, and stakeholder expectations while resolving issues and escalating as needed.

Assist in execution of financial, compliance, and operational audits; evaluate internal controls; test procedures and document findings; prepare audit reports with corrective recommendations; perform special studies (including fraud prevention); and support other auditors to improve audit efficiency.

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.