Remote in South Carolina, USA
Remote only
Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina subsidiary companies.
Location: This position is full-time (40-hours/week) Monday-Friday working REMOTE in the United States or 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.
Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.
Sponsorship: This position is not eligible for sponsorship now or in the future.
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:
Health insurance industry experience
Experience in INPATIENT Rehabilitation
Medicare policy knowledge and 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:
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.
Pay Transparency Statement:
Please note that this range represents the pay range for this and other positions that fall into this pay grade. Compensation decisions within the range will be dependent upon a variety of factors, including experience, geographic location, and internal equity.
Pay Range
Pay Range Min:
$206,011.00
Pay Range Mid:
$309,767.00
Pay Range Max:
$413,523.00
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 mycareer.help@bcbssc.com or call 800-288-2227, 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.
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