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BlueCross BlueShield of South Carolina jobs - 478 jobs

  • Consultant, Sr Provider Education

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in South Carolina or remote

    Logistics: Palmetto GBA,- one of BlueCross BlueShield's South Carolina subsidiary companies. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. Location: This a full-time remote position. You will work an 8-hour shift scheduled during our normal business hours of 8:00 a.m.-5:00 p.m. Monday - Friday. It may be necessary, given the business need to work occasional overtime. What You'll Do: Communicates/educates providers on issues such as Medicare coverage, utilization statistics, documentation and medical review by use of written advisories, reports, letters, and telephone contacts. Documents all provider contacts/communications in provider tracking system. Conducts formal conference calls and/or in-person educational visits with providers that are consistently over utilizing services, on progressive corrective action, or have unacceptable denial rates and/or error rates under the medical review program. Conducts coverage and documentation workshops for provider staff (Medicare providers and physicians' staff). Researches, composes, and coordinates the preparation of all regulatory based provider education materials. Performs analysis of effective reports to determine actions to be taken regarding medical reviewed its/audits. Determines what providers are over-utilizing services and what services are being over-utilized. Works with medical review department and provides input regarding actions taken in response to provider billing practices. Targets providers where greatest abuse of Medicare program has occurred. Participates in the medical review process and inter reviewer reliability (IRR) studies. Assists in training of medical review associates regarding coverage and medical review process. To Qualify for This Position, You'll Need the Following: Required Education: If LPN, graduate of accredited School of Licensed Practical Nursing; if LVN, graduate of accredited School of Licensed Vocational Nursing; if RN, graduate of approved School of Nursing. Required Experience: If LPN or LVN, 7 years of clinical experience or equivalent combination of clinical and educator experience. If RN, 5 years of clinical experience or equivalent combination of clinical and educator experience. Required Software and tools: Microsoft Office. Required Skills and Abilities: Knowledge of medical terminology and disease processes. Demonstrated proficiency in word processing and spreadsheet software. Good judgment skills. Effective customer service, organizational, and presentation skills. Demonstrated proficiency in spelling, punctuation, and grammar. Analytical or critical thinking skills. Basic business math proficiency. Knowledge of mathematical or statistical concepts. Ability to persuade, negotiate, or influence. Required Licenses and Certificates: Active LPN or LVN licensure in state hired, OR active compact multistate LPN license as defined by the Nurse Licensure Compact (NLC), OR active RN licensure in state hired OR active compact multistate RN license as defined by the Nurse Licensure Compact (NLC) others. Ability to handle confidential or sensitive information with discretion. We Prefer That You Have the Following: Preferred Work Experience: 3 years of provider relations and Medicare experience. Preferred Skills and Abilities: Knowledge of claims processing software. In-depth knowledge of Medicare program, guidelines, regulations governing coverage. Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $76k-108k yearly est. Auto-Apply 12d ago
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  • Medicare Medical Director

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Columbia, SC

    Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: As a member of the senior management team, the Medicare Medical Director provides administrative oversight to the medical staff, analyzes medical review utilization data, researches new medical procedures or technology, and acts as a resource to providers and internal staff on issues concerning medical policies. The Medicare Medical Director will write and revise medical policies. Description Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday working ONSITE at our GPC location at 17 Technology Circle, Columbia, SC. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. What You'll Do: Supports operations in the form of case review on both medical and regulatory matters. Develops claim adjudication criteria for situations requiring medical judgment. Provides input on issues and operational policies, processes, and procedures. Educates staff and medical community on various aspects of medical policy and program administration. May develop and update medical policy in consultation with appropriate regulatory personnel, medical consultants, and professional societies. Develops external relationships with the medical community and serves as liaison between these entities and the contractors. Reviews physician and provider practice pattern analysis and other statistical data related to unusual medical service utilization. Conducts research into new or controversial medical procedures and technology. To Qualify for This Position, You'll Need the Following: Required Education: Doctorate in a job related field. Required Experience: 5 years post graduate experience in direct patient care. Required Software and tools: Microsoft Office Required Skills and Abilities: Excellent verbal and written communication skills. Excellent customer service, organizational, and presentation skills. Good judgment skills. Proficiency in spelling, punctuation, and grammar. Ability to persuade, negotiate, or influence others. Ability to work as a team member as well as a leader. Knowledge of medical and utilization review techniques. Required Licenses and Certifications: Active state medical license and current board certification in a recognized specialty. We Prefer That You Have the Following: Medicare policy knowledge and experience Experience working as a Cardiologist or Internist 10+ years of post graduate experience in direct patient care Our comprehensive benefits package includes the following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews with those candidates who are the most qualified, with prioritization given to those candidates who demonstrate the required qualifications. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $191k-269k yearly est. Auto-Apply 50d ago
  • Lead Experience Researcher - Remote Health UX & Strategy

    Humana Inc. 4.8company rating

    Remote or Juneau, AK job

    A leading health company is seeking a Lead Experience Researcher to inform experience strategy by identifying customer needs and translating insights into actionable recommendations. This role requires expertise in qualitative and quantitative research, and collaboration with product and design teams. Ideal candidates have a background in research design and a passion for human-centered innovation. The position is remote, requiring collaboration during central or eastern hours, and includes an attractive compensation package of $138,900 - $191,000 per year. #J-18808-Ljbffr
    $138.9k-191k yearly 4d ago
  • Risk Adjustment Risk Lead & Compliance Strategist

    Humana Inc. 4.8company rating

    Remote or Boston, MA job

    A leading health services company is seeking a Risk Management Lead responsible for oversight of risk adjustment operations. The role includes advising on risk management strategies, compliance, and project management. The ideal candidate should have significant experience in project leadership and risk analysis, with a passion for enhancing consumer experiences. This remote position requires strong initiative and the ability to manage multiple projects simultaneously. Interested candidates are encouraged to apply for a rewarding opportunity focused on health improvement. #J-18808-Ljbffr
    $92k-126k yearly est. 1d ago
  • Actuary, Analytics & Forecasting - Remote FP&A Leader

    Humana Inc. 4.8company rating

    Remote or Urban Honolulu, HI job

    A leading healthcare provider in Hawaii seeks an Actuary Analytics/Forecasting professional. The role involves analyzing and forecasting financial data to support strategic decisions. Ideal candidates will hold relevant degrees and possess strong communication skills with experience in modeling and pricing. This remote position offers a competitive salary range between $129,300 and $177,800, along with comprehensive benefits and a bonus incentive plan. #J-18808-Ljbffr
    $45k-60k yearly est. 5d ago
  • Remote Finance Data Platform Leader

    Humana Inc. 4.8company rating

    Remote or Boston, MA job

    A leading healthcare organization seeks an Associate Director for Finance Data Management to oversee data configuration and implement policies. This role requires a Bachelor's degree, at least 6 years of finance-related experience, and management expertise. Candidates should be proficient in SQL and familiar with Oracle Fusion Cloud and cloud platforms like Databricks. The position offers a pay range of $129,300 to $177,800 annually and is eligible for a bonus based on performance. #J-18808-Ljbffr
    $129.3k-177.8k yearly 1d ago
  • Remote Workforce Management Analyst II

    Humana Inc. 4.8company rating

    Remote or Urban Honolulu, HI job

    A leading healthcare company is looking for a Workforce Management Professional to apply analytics and people metrics to strategic workforce decision-making. The role involves assessing staffing needs and ensuring the alignment of organizational strategies. Candidates should have at least 2 years of relevant experience and excel in communication and analytical problem-solving. This position offers a competitive salary and benefits and requires occasional travel for training. A bachelor's degree is preferred. #J-18808-Ljbffr
    $47k-57k yearly est. 2d ago
  • Remote Finance Special Projects Lead

    Humana Inc. 4.8company rating

    Remote or Urban Honolulu, HI job

    A healthcare organization is seeking a Lead - Finance Special Projects in Honolulu, Hawaii to drive process improvements within Finance. The ideal candidate will have a Bachelor's degree, extensive experience in benchmarking, and strong analytical skills. This role involves collaboration with Finance leadership to implement solutions optimizing operations. Occasional travel is required. The compensation range is $94,900 - $130,500 annually, with additional bonuses and comprehensive benefits. #J-18808-Ljbffr
    $94.9k-130.5k yearly 5d ago
  • Representative, Provider Relations

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Columbia, SC

    Provides education and training support for network providers/staff/suppliers/physicians/beneficiaries/referral agents as necessary. Develops and produces training and educational materials. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 17 Technology Circle, Columbia, SC 29203. What You'll Do: Develops/prepares/reviews/updates all provider education materials. These may include new highlights, calendar of events, job aids, resource tools, and web page content. conducts/facilitates workshops, training class materials in support of teleconferences with providers, provider groups, staff, suppliers, physicians, beneficiaries, referral agents. Supports relationships with providers, provider groups, staff, suppliers, physicians, beneficiaries, referral agents, state/local medical/professional associations. Responds to educational needs. Performs administrative functions in support of education and training. Produces/generates various reports to management and provides feedback on activities to management. Contributes/participates/completes special projects as assigned. To Qualify for This Position, You'll Need the Following: Required Education: Bachelor's degree Degree Equivalency: 4-years job-related work experience OR Associate's and 2-years job related work experience Required Work Experience: 2-years of experience in customer service, claims processing, communications, education/training, provider relations, healthcare, or a combination. Required Skills and Abilities: Demonstrated skills related to training materials development. Demonstrated skills related to classroom presentations to large groups. Demonstrated proficiency in word processing and spreadsheet software. Good judgment skills. Effective customer service, organizational, and presentation skills. Demonstrated verbal and written communication skills. Analytical and critical thinking skills. Basic business math proficiency. Ability to persuade, negotiate, or influence others. Ability to handle confidential or sensitive information with discretion. Ability to identify learning objectives. Strong course design skills to include use of media/other instructional methods. Ability to evaluate progress in addition to actual delivery of training sessions. Required Software and Tools: Microsoft Office We Prefer That You Have the Following: Preferred Requirements: Bachelor's degree in Communications/Journalism, English, Education, Training, Healthcare Administration, or Nursing. Preferred Work Experience: 2-years' experience in claims processing, graphic design/publications, provider network, sales/marketing, insurance industry training. Preferred Skills and Abilities: Knowledge of claims processing, government healthcare programs. Ability to acquire working knowledge/understanding of specific programs. Ability to acquire working knowledge/understanding of Medicaid, Medicare. Ability to acquire working knowledge/understanding of HIPAA policies/procedures Preferred Software and Other Tools: Working knowledge of Microsoft Access or other database software. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $35k-49k yearly est. Auto-Apply 8d ago
  • Sales Consultant II - New Business Development (Remote)

    Carefirst 4.8company rating

    Remote or Baltimore, MD job

    **Resp & Qualifications** _CANDIDATES MUST LIVE IN THE MD, DC, NORTHERN VIRGINIA AREA IN ORDER TO TRAVEL INTO THE OFFICES AND FOR CLIENT MEETINGS AND STAFF MEETINGS_ **PURPOSE:** This position is responsible for **new business development** within the **middle market customer** space. This role leads sales initiatives and strategies as well as relationship building with both our external partners and prospects as well internal constituents. The sales consultant position requires a level of knowledge and understanding for selling to fully and self-insured customers with complex benefit arrangements. **ESSENTIAL FUNCTIONS:** + Achieve sales goals and profitable growth for the organization. + Position and sell multiple lines of coverage, medical, stop loss, dental and vision. + Excellent written and presentation skills. + Strategize on proposals to ensure we are meeting the clients objectives and delivering our value proposition. + Be proactive, organized, responsive, detail oriented and track all sales data within the required platforms. + Develop long term relationships with both internal and external constituents. + Ability to strategize and organize a team of subject matter experts for finalist meetings. + Continuously meet with our consultant partners and keep them informed on new products, updates, and relevant information to their business. **SUPERVISORY RESPONSIBILITY:** Position does not have direct reports but does require working closely with internal constituents to develop strategies for selling and presenting to consultants and prospects. **QUALIFICATIONS:** **Education Level:** Bachelors degree in business, Insurance Industry, or related field OR in lieu of a bachelors degree, an additional 4 years of relevant work experience is required in addition to the required work experience. **Licenses/Certifications:** + Current health and life license for the jurisdictions of Maryland, DC, and Virginia Required. **Experience:** 5 years sales/healthcare in a similar sales position. **Preferred Qualifications:** + 5+ years experience in a similar sales position with a competitor or similar industry. **Knowledge, Skills, and Abilities (KSAs)** + Ability to recognize, analyze, and solve for prospects challenges. + Excellent communication skills both written and verbal. + Must be able to meet established deadlines for proposals and work closely with internal constituents. **Travel Requirements** **Estimate Amount:** 80% This position is expected to travel to see consultants and prospective clients within the DC metro area. **Salary Range:** $72,000 - $117,000 **Salary Range Disclaimer** The disclosed range estimate has not been adjusted for the applicable geographic differential associated with the location at which the work is being performed. This compensation range is specific and considers factors such as (but not limited to) the scope and responsibilites of the position, the candidate's work experience, education/training, internal peer equity, and market and business consideration. It is not typical for an individual to be hired at the top of the range, as compensation decisions depend on each case's facts and circumstances, including but not limited to experience, internal equity, and location. In addition to your compensation, CareFirst offers a comprehensive benefits package, various incentive programs/plans, and 401k contribution programs/plans (all benefits/incentives are subject to eligibility requirements). **Department** CMLG New Business MD **Equal Employment Opportunity** CareFirst BlueCross BlueShield is an Equal Opportunity (EEO) employer. It is the policy of the Company to provide equal employment opportunities to all qualified applicants without regard to race, color, religion, sex, sexual orientation, gender identity, national origin, age, protected veteran or disabled status, or genetic information. **Where To Apply** Please visit our website to apply: ************************* **Federal Disc/Physical Demand** Note: The incumbent is required to immediately disclose any debarment, exclusion, or other event that makes him/her ineligible to perform work directly or indirectly on Federal health care programs. **PHYSICAL DEMANDS:** The associate is primarily seated while performing the duties of the position. Occasional walking or standing is required. The hands are regularly used to write, type, key and handle or feel small controls and objects. The associate must frequently talk and hear. Weights up to 25 pounds are occasionally lifted. **Sponsorship in US** Must be eligible to work in the U.S. without Sponsorship \#LI-KL1 REQNUMBER: 21368
    $35k-60k yearly est. 60d+ ago
  • Remote Market VP Pharmacy Compliance & Practice

    Humana Inc. 4.8company rating

    Remote or Boston, MA job

    A leading healthcare company in the United States seeks a Market Vice President of Pharmacy Professional Practice to oversee compliance across pharmacies. This role involves ensuring adherence to regulations while leading a team of professionals. The ideal candidate will possess a Bachelor's degree in Pharmacy, an active pharmacist license, and have substantial experience in pharmacy compliance. Competitive compensation includes a salary range of $223,800 - $313,100 per year with bonus eligibility and comprehensive benefits. #J-18808-Ljbffr
    $99k-123k yearly est. 2d ago
  • Utilization Management Pharmacist

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Columbia, SC

    This role is primarily responsible for developing, maintaining, and producing clinical decision-support logic within the prior authorization (PA) review platform, as well as ensuring the platform's ongoing functionality and accuracy. The pharmacist may also contribute to the Pharmacy and Therapeutics (P&T) Committee by preparing and presenting therapeutic class reviews and drug monographs. Additionally, this position supports PA processing by applying evidence-based clinical guidelines and criteria to promote the appropriate use of medications. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: This role is primarily responsible for developing, maintaining, and producing clinical decision-support logic within the prior authorization (PA) review platform, as well as ensuring the platform's ongoing functionality and accuracy. The pharmacist may also contribute to the Pharmacy and Therapeutics (P&T) Committee by preparing and presenting therapeutic class reviews and drug monographs. Additionally, this position supports PA processing by applying evidence-based clinical guidelines and criteria to promote the appropriate use of medications. Location: This role is located at 4101 Percival Road, Columbia, SC 29229. This role is from 8am - 5pm, Monday through Friday. What You'll Do: Conducts utilization management prior authorization reviews and evaluates opportunities to improve health outcomes and derive optimal value from health care resources. Analyzes and reviews prior authorization requests for compliance with clinical criteria and treatment care guidelines, potential patient safety problems, including drug interactions, suboptimal medication regimens, duplicate therapy and cost savings opportunities. Formulates recommendations to optimize the patients' medication regiment applying evidence based medicine and national treatment guidelines. Informs prescribers of potential drug therapy problems and influences prescribing. Engages with and establishes credibility with members and physicians as a trusted source of information. Provides information and coordinates activities with other care and disease management programs and serves as a clinical pharmacy resource. Contributes to the development of clinical rules and decision trees for evaluating the appropriateness of drug therapy. To Qualify For This Position, You'll Need The Following: Required Education: Bachelor's in a job related field Required Work Experience: 3 years of clinical experience to include 1 year of experience with management of patient drug therapies that includes conducting utilization management and/or medication therapy management reviews. Required Skills and Abilities: Strong clinical pharmacy knowledge. Excellent communication (verbal and written), and interpersonal skills. Ability to exercise good judgment with a capacity of communicating with a diverse range of individuals. Ability to handle confidential or sensitive information with discretion. Strong customer service skills. Commitment to professionalism and to advance patient care. Required Software and Tools: Microsoft Office. Required Licenses and Certificates: Active, unrestricted pharmacy licensure in SC or state of residence. We Prefer That You Have The Following: Preferred Training: Any additional certifications in Medication Therapy Management, immunotherapy, oncology, hemophilia, multiple sclerosis, or specialty related disease states is helpful. Preferred Work Experience: Utilization Management program experience preferred including working with prior authorization program platforms. Managed Medicaid experience working with preferred drug lists and UM criteria application. Preferred Skills and Abilities: Knowledge and expertise with management of specialty drug therapies. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $106k-127k yearly est. Auto-Apply 22d ago
  • Summer Student Intern - Underwriting

    Bluecross and Blueshield of South Carolina 4.6company rating

    Bluecross and Blueshield of South Carolina job in Columbia, SC

    We have a job opening for the position Underwriting Summer Student Intern at Companion a subsidiary BlueCross BlueShield of South Carolina. The Intern position is utilized for training an active college student towards a professional-level role. The responsibilities vary and are based upon the needs of the area and the experience of the incumbent at the time of employment. This incumbent works under direct supervision and has responsibilities for performing entry-level tasks and for learning professional-level tasks relating to area operations. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allow us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team! Description Logistics: Companion Data Services - one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This is a full-time internship (40 hours/week) Monday-Friday working on-site at 1301 Gervais St, Columbia, SC 29201, in an office environment. What You'll Do: Completes tasks for maintaining information used in the department. Maintains documents, spreadsheets, databases or related items. Utilizes various systems and tools, performs research and assists with projects as needed. Follows established procedures. Participates in business unit/department training designed to help this position acquire applicable knowledge/skills in their area of study. Completes area tasks that are conducive to learning the departmental procedures and applying industry/field best practices. May communicate with other areas of the company. May create, present and/or report on area statistics and/or knowledge acquired. Perform tasks that help in learning the business area and which provide an overall view of company operations. Assist other staff members with everyday tasks to gain an understanding of business operations and workflow. Completes other assigned area related tasks. To Qualify For This Position, You'll Need The Following: Required Education: High School Diploma or equivalent Required Specialized Training: Must have a minimum of 12 semester hours earned in the field(s) specified by the hiring area and must be currently enrolled in college and working towards obtaining at least a 4-year degree in the field(s) specified by the hiring area. (PLEASE UPLOAD A COPY OF YOUR UNOFFICIAL TRANSCRIPTS(S) WITH RESUME.) Required Work Experience: No previous work experience is required. Required Skills and Abilities: Effective oral and written communication skills. Strong organizational abilities and a keen attention to detail. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Good planning and multi-tasking skills. Proficient listening skills, coupled with the capability to adhere to instructions and pose inquiries, are essential for ensuring a productive internship. Required Software and Tools: Microsoft Office. We Prefer That You Have The Following: Microsoft Office. 1 year-general work history/experience. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: (Standard, unless otherwise directed) We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: (Standard, unless otherwise instructed during intake) After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $45k-70k yearly est. Auto-Apply 60d+ ago
  • Technician, Accounting III

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Columbia, SC

    Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Position Purpose: Under general supervision, performs a variety of routine to complex clerical/accounting functions such as inventory balancing, reconciliations, generating refund request letters, processing disbursements and deposits, keying journal entries and logging items in accordance with standard procedures in one or more of the following areas: general accounting, accounts payable, accounts receivable or related financial area. Completes special projects and resolves routine problems. Logistics: Palmetto GBA - one of BlueCross BlueShield of South Carolina's subsidiary companies. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift within the hours of 7:00AM-7:00PM. You will have the potential to W@h after a required training period. This role is located at 17 Technology Circle Columbia SC 29203. What You'll Do: Prepares various in-depth financial data associated with refunds, invoices, recoupments, adjustments, cash disbursements, deposits, check voids and reissues, disputes, correspondence, or other data in support of the finance or accounting function. Ensures data is complete, accurate, and organized for processing. Provides supervisor with daily, weekly, and/or monthly summary reports of accounting activities for the position. Completes moderately difficult to complex research using financial reporting systems, files, and other means to identify errors such as overpayments or misapplication of funds. Resolves most questions and problems, referring most complex issues to higher levels. Performs calculations on financial documents to ensure accuracy of bank deposits, receipts, disbursements, refunds, or other accounting-related items. Provides other support duties related to the accounting/finance function that may include monitoring financial systems, tracking funds, balancing accounts, maintaining inventory and receiving cash funds from customers, etc. Assists less experienced accounting clerks as needed. Prepares journal entries and account reconciliations. Responds to telephone and written inquiries from internal and external customers to ensure accurate billing, payments and/or collections. To Qualify For This Position, You'll Need The Following: Required Education: Bachelor's in a job-related field. Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience. Good oral and written communication and customer service skills. Excellent organization skills and attention to detail. Strong business math skills. Microsoft Office. We Prefer That You Have The Following: Proficiency in Microsoft Excel and Word. Accounting related or Banking experience; highly preferred. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more. What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $29k-36k yearly est. Auto-Apply 36d ago
  • Claims Processor I - PGBA-27

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Florence, SC

    Logistics: PGBA- one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) Monday-Friday from 8am-5pm in a typical office environment. It may be necessary, given the business need to work occasional overtime. The role is located on-site at 200 N Dozier Blvd., Florence, SC 29501. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act ( SCA ). To comply with the McNamara-O'Hara Service Contract Act (SCA), employees must enroll in our health insurance even if they have other health insurance. Employees will receive supplemental pay for health insurance until they are enrolled in our health insurance, first of the month following 28 days after the hire date. What You'll Do: Researches and processes claims according to business regulation, internal standards and processing guidelines. Verifies the coding of procedure and diagnosis codes. Resolves system edits, audits and claims errors through research and use of approved references and investigative sources. Coordinates with internal departments to work edits and deferrals, updating the patient identification, other health insurance, provider identification and other files as necessary. To Qualify for This Position, You'll Need the Following: Required Education: High School Diploma or equivalent Required Skills and Abilities: Strong analytical, organizational and customer service skills. Strong oral and written communication skills. Proficient spelling, punctuation and grammar skills. Good judgment skills. Basic business math skills. Required Software and Tools: Basic office equipment. We Prefer That You Have the Following: Preferred Work Experience: 1 year-of experience in a healthcare or insurance environment. Preferred Skills and Abilities: Ability to use complex mathematical calculations. Preferred Software and Other Tools: Proficient in word processing and spreadsheet applications. Proficient in database software. Proficient in word processing and spreadsheet applications. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $33k-52k yearly est. Auto-Apply 6d ago
  • RN Concierge Care Manager - Case Management

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Columbia, SC

    We are currently hiring for an RN Concierge Care Manager - Case Management to join BlueCross BlueShield of South Carolina. In this role as an RN Concierge Care Manager - Case Management, you will provide care management services to more than 2 million members in South Carolina and nationally, administer complex, high-touch concierge case management for members identified into specialized programs such as high-risk maternity, NICU, ESRD, Cancer, Palliative Care or Behavioral Health, identify risks and provides outreach services to facilitate the coordination of healthcare services and gap closure, and provide individualized care plans to ensure cost-effectiveness, overall care satisfaction, and improved quality of life. Description The position will be fully remote on a desktop computer to provide highly interactive case management to assigned members. Members will include those with chronic or high-risk conditions and those who are admitted to inpatient care. You will educate and guide members through prior authorizations and understanding the need to adhere to medications and the plan of care. Most interactions will be by phone and through our messaging system, perfect for those who love case management and improving the lives and medical outcomes of members while working in your own home office. To be considered, attach a copy of your current RN license report to your application, or Include your RN license number on your resume. Candidates who live within 50 miles of the Columbia office (4101 Percival Rd Ste 120, Columbia, SC 29229) and reside in South Carolina will be required to come on-site for one day of orientation to receive their equipment. After orientation, the position will be fully remote. This requirement does not apply to candidates residing in other states. Location This position is full-time (40 hours/week) Monday-Friday from 8:00am-4:30pm EST or 8:30am-5:00pm EST and will be fully remote. To work from home, you must have high-speed (non-satellite) internet and a private, secure home office. What You'll Do: Directs day-to-day, high-touch member management to include implementation of program goals, coordination of treatment plans and benefit coordination for high-risk patient populations and/or those with complex conditions. Coordinates clinical services with external sources to include: providers, vendors, facilities, social workers/case managers and/or community services. Participates in team training and continuing medical education. Prepares for external audits and quality assurance efforts. To Qualify for This Position, You'll Need the Following: Required Education: Associate's degree in nursing OR Graduate of Accredited School of Nursing OR master's degree in social work, Psychology, or Counseling (Div. 75 and 6B) only. Required Work Experience: 5 years' case management experience as an RN OR 2 years' case manager experience as an RN in a health insurance environment. Required Skills and Abilities: Working knowledge of word processing software, knowledge of quality improvement processes and demonstrated ability with these activities, knowledge of contract language and application, ability to work independently, prioritize effectively, and make sound decisions, demonstrated customer service, organizational and presentation skills, demonstrated proficiency in spelling, punctuation, and grammar skills, demonstrated oral and written communication skills, ability to persuade, negotiate, or influence others, analytical or creative thinking skills, ability to handle confidential or sensitive information with discretion. Required Software and Tools: Microsoft Office Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire; OR active, compact, multistate, unrestricted RN license as defined by the Nurse Licensure Compact (NLC); OR active licensure as a social worker, psychologist, or counselor in state of hire (Div. 75 only). Nationally recognized Case Management certification to be obtained within 2 years of hire as a Case Manager. We Prefer That You Have the Following: Preferred Education: Bachelor's degree in health-related field (Nursing, Healthcare Administration, Pharmacy, Sciences, Applied Health) Preferred Work Experience: 5 years' experience in case management in a sub-specialty area (i.e. ICU, Palliative Care, Hospice, or Home Health, Behavioral health, and Case Management.) Preferred Skills and Abilities: Strong communication and customer services skills, excellent analytical skills to problem solve and remedy issues immediately, ability to work in an autonomous environment or leadership capacity. Preferred Software and Tools: Working knowledge of Microsoft Word, PowerPoint, Excel, or other spreadsheet/database software; TMCS, LiveOps, MDDS, and BlueVue. Preferred Licenses and Certificates: Case manager certification, clinical certification in specialty area. Basic Life Support (BLS) or Advanced Cardiac Life Support (ACLS) certification. Our Comprehensive Benefits Package Includes The Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits for the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $72k-91k yearly est. Auto-Apply 60d+ ago
  • Senior Infra Ops Lead: Cloud & GenAI Enablement (Remote)

    Humana Inc. 4.8company rating

    Remote or Boston, MA job

    A leading healthcare company is seeking an experienced Infrastructure Operations leader to drive innovation in AI and cloud technologies. The ideal candidate will have over 10 years in infrastructure, with a strong background in AI/ML, leading cloud operations for Azure and AWS. Key responsibilities include overseeing cloud strategy and governance, enhancing operational performance, and fostering partnerships across teams. This role offers a competitive salary and benefits focused on well-being. #J-18808-Ljbffr
    $114k-139k yearly est. 3d ago
  • Developer IV - PGBA

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Columbia, SC

    Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we've been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team! Description Position Purpose: Responsible for analysis, design, programming, and implementation of complex applications tasks and projects. Devise feasible, logical procedures to resolve business problems through the use of computer resources. Formulate scope and objectives through research to develop or modify complex systems. Review detailed specifications and recommend modifications. Design, code, test and debug complex application programs. What You Will Do: Produce deliverables related to the assigned project. Perform analysis, design, programming, and implementation of systems and procedures to solve complex business or scientific problems. Evaluate interrelationships in immediate programming area to determine how changes in one program will affect another related area. Apply conversions and enhancements to business systems. May lead or provide expertise on assigned projects. Work closely with customers, business analysts, and team members to understand business requirements that drive the analysis and design of quality technical solutions. Ensure solutions are aligned with business and IT strategies and comply with the organization's architectural standards. Assist in post-implementation support and system enhancements. Test modified programs, create necessary test files and data, verify logic, debug, and write relevant documentation. Design and develop IT systems. Devise new sources of data and develop new approaches and techniques. Involved in the full systems life cycle and is responsible for designing, coding, testing, implementing, maintaining and supporting complex application software that is delivered on time and within budget. Provide guidance to lower-level programmers/analysts. Act as an internal consultant by providing technical guidance on complex projects. Determine and resolve problems with other systems analysts, programmers, and systems users. Test designed programs, verify logic, perform any necessary "debugging," and write the documentation. To Qualify For This Position, You Will Need: Required Education: Bachelor's in a job related field Or an additional 4 years job related work experience Or Associate's and an additional 2 years job related work experience Required Work Experience: 6 years-of application development, systems testing or other job related experience. Required Skills and Abilities: Comprehensive understanding of applications/development, quality assurance and integration methodologies, concepts and facilities in a mainframe, midrange, web, and/or PC/LAN environment. Demonstrates a high level of technical proficiency in the areas of programming languages, platform capabilities, and methods of systems analysis and program design. Excellent analysis, decision-making, and problem solving skills. Demonstrates logical abstract thinking and assimilating/adhering to project goals and deadlines. Ability to communicate effectively verbally and in writing. Able to work well under pressure and as part of a team. Strong knowledge of interpersonal skills/team building. Familiar with project management concepts. Ability to assess requirements, alternatives, and risks/benefits for low- to high-impact projects. Pays attention to detail. Ability to establish and maintain effective working relationships with employees, clients, vendors etc. In-depth understanding of organizational functions, behavior, and inter-relationships. Required Software and Other Tools: Comprehensive knowledge of relevant operating systems, programming languages, and development tools and their usage in the company. We Prefer That You Have: Reporting/Data Warehouse experience Claims experience Work Environment: Customer-focused, project-oriented programming environment. Fast paced, multi-platformed environment which may require action and response 24X7 to support the technical business needs of the customer. What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. Our comprehensive benefits package includes: · 401(k) retirement savings plan with company match · Subsidized health plans and free vision coverage · Life insurance · Paid annual leave - the longer you work here, the more you earn · Nine paid holidays · On-site cafeterias and fitness centers in major locations · Wellness programs and a healthy lifestyle premium discount · Tuition assistance · Service recognition What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Management will be conducting interviews. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $84k-103k yearly est. Auto-Apply 10d ago
  • Behavioral Health Care Management Supervisor

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Columbia, SC

    We are currently hiring for a Behavioral Health Care Management Supervisor to join BlueCross BlueShield of South Carolina. In this role as a Behavioral Health Care Management Supervisor, you will be responsible for the supervision and maintenance of the daily functions of the following areas: Utilization Review/Review Nurses, Case Management, Medical Review, Health/Disease Management, Quality Management, and/or Appeals, to include departmental staff and specialty programs. Responsible for all data collection for specialty programs and ensures appropriate levels of healthcare services are provided. Description Location: This position is full-time (40-hours/week) Monday-Friday from 8:00am-5:00pm and will be hybrid in Columbia, SC. The candidate will be required to report on-site occasionally for trainings, meetings, or other business needs and will be required to conduct member-facing patient visits within South Carolina. What You'll Do: Supervises day-to-day activities for assigned staff. Identifies training needs of staff. Verifies accuracy, efficiency, and effectiveness of workflow functions. Develops and oversees the implementation and administration of specialty programs (wellness, preventive, and/or employer work site programs). Supervises staff to include approval of time, leave, performance reviews, etc. Selects/trains/motivates staff in providing excellent customer service with customers, marketing, management/others. Develops/maintains/updates procedures/documentation for conducting audits. Develops/communicates department standards and expectations of staff. Performs quality control functions for work performed. Develops work plans to improve quality performance. Conducts analysis of program component. Collects data for outcomes reporting. Prepares/reviews/maintains weekly/monthly reports for management. Oversees all data collection and URAC/NCQA compliance activities for related programs. Coordinates with other corporate departments to ensure effective communication. To Qualify for This Position, You'll Need the Following: Required Education: Associate's in a job-related field Degree Equivalency: Graduate of Accredited School of Nursing Required Work Experience: 5 years A combination of health promotion, health education, health insurance, clinical, medical, pharmacy or other healthcare experience. If Master's Degree, required experience is three years. One year experience in team lead/leadership role or equivalent military experience in grade E4 or above (may be concurrent). Required Skills and Abilities: Understanding of insurance and benefit programs as it relates to health management coverage. Working knowledge of managed care and/or various forms of health care delivery systems. Knowledge of specific criteria/protocol sets and the use of the same. Knowledge/understanding of the quality improvement process. Ability to work independently, prioritize effectively, and make sound decisions. Excellent communication skills. Ability to work with a wide variety of internal and external customers. Good judgment skills. Demonstrated customer service, organizational, and presentation skills. Demonstrated verbal and written communication skills. Analytical, critical thinking, and math skills necessary to collect, analyze, and report data. Ability to persuade, negotiate, or influence others. Ability to handle confidential or sensitive information with discretion. Ability to direct, motivate, and assess performance of others. Required Software and Tools: Microsoft Office. Required Licenses and Certificates: Active, unrestricted RN licensure from the United States and in the state of hire, OR, active compact multistate unrestricted RN license as defined by the Nurse Licensure Compact (NLC); OR, active, unrestricted Professional Healthcare Licensure and/or Certification from the United States and in the state of hire, in area of specialty; OR, active, unrestricted licensure as Licensed Master Social Worker, Licensed Independent Social Worker, or Licensed Professional Counselor from the United States and in the state of hire; OR, if Master's in Public Health or Healthcare Administration, three years of additional experience in health-related field. Must be certified in Case Management by a URAC accrediting body within 3 years of hire into the position (for non-Medicaid only). What We Prefer You to Have: Previous Case Management experience. Previous Managed Care experience. Previous experience working with complex behavioral health conditions. Our Comprehensive Benefits Package Includes the Following: We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment. Subsidized health plans, dental and vision coverage 401k retirement savings plan with company match Life Insurance Paid Time Off (PTO) On-site cafeterias and fitness centers in major locations Education Assistance Service Recognition National discounts to movies, theaters, zoos, theme parks and more What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $77k-99k yearly est. Auto-Apply 14d ago
  • Marketing Student Intern

    Bluecross Blueshield of South Carolina 4.6company rating

    Bluecross Blueshield of South Carolina job in Columbia, SC

    We have a job opening for the position of Marketing Student Intern at BlueCross BlueShield of South Carolina. Intern position is utilized for training an active college student towards a professional-level role. The responsibilities vary and are based upon the needs of the area and the experience of the incumbent at the time of employment. This incumbent works under direct supervision and has responsibilities for performing entry-level tasks and for learning professional-level tasks relating to area operations. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allow us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team! Description Location: This is a full-time internship (40 hours/week) Monday-Friday working on-site at 4101 Percival Rd, Columbia, SC 29229, in an office environment. What You'll Do: Completes tasks for maintaining information used in the department. Maintains documents, spreadsheets, databases or related items. Utilizes various systems and tools, performs research and assists with projects as needed. Follows established procedures. Participates in business unit/department training designed to help this position acquire applicable knowledge/skills in their area of study. Completes area tasks that are conducive to learning the departmental procedures and applying industry/field best practices. May communicate with other areas of the company. May create, present and/or report on area statistics and/or knowledge acquired. ·Perform tasks that help in learning the business area and which provide an overall view of company operations. Assist other staff members with everyday tasks to gain an understanding of business operations and workflow. Completes other assigned area related tasks. To Qualify For This Position, You'll Need The Following: Required Education: High School Diploma or equivalent Required Specialized Training: Must have a minimum of 12 semester hours earned in the field(s) specified by the hiring area and must be currently enrolled in college and working towards obtaining at least a 4-year degree in the field(s) specified by the hiring area. (PLEASE UPLOAD A COPY OF YOUR UNOFFICIAL TRANSCRIPTS(S) WITH RESUME.) Required Work Experience: No previous work experience is required. Required Skills and Abilities: Effective oral and written communication skills. Strong organizational abilities and a keen attention to detail. Analytical or critical thinking skills. Ability to handle confidential or sensitive information with discretion. Good planning and multi-tasking skills. Proficient listening skills, coupled with the capability to adhere to instructions and pose inquiries, are essential for ensuring a productive internship. Required Software and Tools: Microsoft Office. We Prefer That You Have The Following: Microsoft Office. 1 year-general work history/experience. Adobe What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company. What To Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. Equal Employment Opportunity Statement BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations. We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company. If you need special assistance or an accommodation while seeking employment, please email ************************ or call ************, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis. We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information. Some states have required notifications. Here's more information.
    $45k-70k yearly est. Auto-Apply 60d+ ago

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Zippia gives an in-depth look into the details of BlueCross BlueShield of South Carolina, including salaries, political affiliations, employee data, and more, in order to inform job seekers about BlueCross BlueShield of South Carolina. The employee data is based on information from people who have self-reported their past or current employments at BlueCross BlueShield of South Carolina. The data on this page is also based on data sources collected from public and open data sources on the Internet and other locations, as well as proprietary data we licensed from other companies. Sources of data may include, but are not limited to, the BLS, company filings, estimates based on those filings, H1B filings, and other public and private datasets. While we have made attempts to ensure that the information displayed are correct, Zippia is not responsible for any errors or omissions or for the results obtained from the use of this information. None of the information on this page has been provided or approved by BlueCross BlueShield of South Carolina. The data presented on this page does not represent the view of BlueCross BlueShield of South Carolina and its employees or that of Zippia.

BlueCross BlueShield of South Carolina may also be known as or be related to BLUECROSS BLUESHIELD OF SOUTH CAROLINA, BlueCross BlueShield of South Carolina, BlueCross BlueShield of South Carolina Inc, Thomas H. Cooper & Co., Inc., BlueCross BlueShield of South Carolina, Inc. and BlueCross BlueShield of SouthCarolina.