BlueCross BlueShield of South Carolina

Summary Working at CGS Administrators CGS Administrators, LLC (CGS) is part of BCBSSC™'s Celerian Group of companies and provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, supporting the needs of over 8.7 million Medicare beneficiaries and 103,000 healthcare professionals nationwide. This is an onsite full-time position located at 26 Century Blvd., Ste. ST610 Nashville, TN 37214-3685. The CGS IT team consists of ~ 80 people. You will be a part of the System Support team, which includes 14 team members with vast and diverse skillsets. We are a Microsoft shop, and our core technologies include C#, .ASP and MS SQL with growing movement to API (Application Programming Interface) tools. The Business System Analyst will assist the team with developing business, project, system requirements, create documentation including process flows, test plans, test matrices, test reporting, etc. Ready to grow? Apply...

Summary Identifies and pursues subrogation and workers compensation recoveries. Manages a workload of approximately 500 cases and the collection of approximately $1,000,000 annually. Description 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-4:30PM. It may be necessary, given the business need to work occasional overtime. This role is located at 4101 Percival Road, Columbia, SC 29229. What You’ll Do Analyzes laws, regulations, and contract language concerning the pursuit of subrogation and workers compensation reimbursements. Reviews claims history to determine the lien amount and assert lien against interested parties based on applicable laws. Negotiates with attorneys, liability carriers, and members for final settlement. under supervision of managing attorney, argues relevant subrogation laws concerning Erisa pre-emption, common...

Summary Responsible for oversight and management of employee benefits plans, including health, dental, vision, life, disability, supplemental insurances, time off plans, and retirement plans. Makes recommendations of improvements based on industry and employee analysis. Monitors contracts and vendor adherence to contracts. Coordinates administration/communication of benefits to employees. Ensures compliance with government regulations, prepares annual benefit tax filings. Description Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. This role is onsite at 51 Clemson Rd. Columbia, SC. Position Purpose: The Total Rewards Benefits Manager oversees and manages employee benefits programs, including health, dental, and retirement plans. This role involves analyzing industry trends for improvements, ensuring compliance with regulations, monitoring vendor performance, and coordinating communication to employees regarding their...

Summary 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 : Develops difficult statistical analysis using standard reporting, AD HOC reporting, and data mining tools in order to identify patterns and trends. Prepares charts, illustrations, and other graphics and narrative reports to...

Summary ELTP is a technical training program in Columbia, SC in which participants are in an initial 4 to 5-month paid classroom training. After successful completion of the program, you will join one of our technology areas related to your field of study where you will continue to grow your career through mentoring, professional development, and career advancement opportunities. These positions require a security clearance, which requires US citizenship to obtain. This training is designed to prepare entry-level IT professionals for a career in application development, support, and/or security. This includes the areas responsible for the development, maintenance, security, and support of corporate and subsidiaries’ websites, voice response units, desktop applications, and infrastructure platforms. The curriculum covers a variety of topics across application development and deployment, IT service management, scripting, automation, networking, and security....

Summary Provides a wide variety of administrative and staff support services. Coordinates more complex and diverse area specific projects. Administers programs, projects and processes requiring area specific knowledge. Operates a desktop computer and is proficient in working with assorted software, tools and systems utilized in the area. Description Location: This position is full-time (40-hours/week) Monday-Friday. 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. This role is located at 4101 Percival Road Columbia, SC 29229-8320. This position does offer a hybrid work schedule consisting of 3 days in office and 2 days remote. What You’ll Do: Provides coordination for a variety of area specific projects. Completes project support functions. Gathers information. Prepares letters, reports, graphs, forms or presentations. Organizes...

Summary Researches, analyzes and documents business processes for developing or enhancing Medicare systems. Assists with needs assessments to align operation solutions with government initiatives. Create and review test data for system changes. Identify, document and assist in the resolution of system-related problems. Coordinate activities for implementation of changes, as well as debugging and retesting of system changes. Description Location: This position is full time (40 hours/week) Monday-Friday 8am-5pm and will be remote 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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive...

Internal Reference Number: R1047424 Summary Responsible for supervising the receipt, review, and settlement of the Medicare cost report, ensuring all Centers for Medicare and Medicaid Services (CMS) requirements are met throughout the process. Description The Government Audit Supervisor is a full-time remote position working 8:00-5:00pm. What You'll Do: Performs supervisory review of all audit work papers completed by the team to ensure all work conforms to CMS and other government auditing standards. Performs supervisory review of all cost report acceptances and desk reviews to ensure timeliness requirements are met and all CMS standards are adhered to. Plans, monitors, and budgets all work assigned for the team, and evaluates and reports results. Performs supervisory review of all settlement packages ensuring product meets all CMS standards. Assists in developing the audit staff by providing on-the-job training as well as preparing...

Summary ELTP is a technical training program in Columbia, SC in which participants are in an initial 4 to 5-month paid classroom training. After successful completion of the program, you will join one of our technology areas related to your field of study where you will continue to grow your career through mentoring, professional development, and career advancement opportunities. This training is designed to prepare entry-level IT professionals for a career in mainframe systems programming and support. These systems are the foundation of our IT department, processing billions of online transactions annually and supporting users and members across the US. The curriculum focuses primarily on COBOL application development, as well as several other languages and technologies. Description What You’ll Do During the training, you will take part in and successfully complete individual and group assignments and projects, including quizzes, tests, homework,...

Summary Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements. Description 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 7:00AM-4:30PM. It may be necessary, given the business need to work occasional overtime. This role is located at 4101 Percival Road, Columbia, SC 29229. What You’ll Do Performs routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed. Recognizes and documents any potential fraud and abuse situations. May provide one...

Summary We have a job opening for the position of Accounting Business Unit Student (Year-Round) Intern at Palmetto GBA, a subsidiary of BlueCross BlueShield of South Carolina. The Intern position is utilized for training an active high school or college student towards an entry 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. The incumbent will work under direct supervision and will be responsible 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...

Summary Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements. Description 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 7:00AM-4:30PM. It may be necessary, given the business need to work occasional overtime. This role is located at 4101 Percival Road, Columbia, SC 29229. What You’ll Do: Performs routine quality audits, reviews, or monitoring across various operations functions to ensure quality standards, procedures, and methodologies are being followed. Recognizes and documents any potential fraud and abuse situations. May...

Summary Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description Logistics: Palmetto GBA – one of BlueCross BlueShield's South Carolina 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 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 onsite at 17 Technology Circle, Columbia, SC, 29203. 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...

Summary Responsible for the accurate and timely processing of claims. Description 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! Position Purpose: Responsible for the accurate and timely processing of claims. Location: This position is full-time (40 hours/week) Monday-Friday from 8:00am-5:00pm....

Summary Develops test plans and test matrices, conducts testing and reports test results for system changes. Coordinates implementation and debugging of new software ensuring that the new or modified applications work in the production environment and meet the expectations of customers. Researches and defines system production issues and works with Information Systems on both short term and long term resolutions. May also partner/communicate with other internal/external customers/plans. Description Location: This role is full time M-F 8am-5pm, onsite at our Florence, SC location. What You Will Do: Reviews projects and change sheets Attends Scope, Design and Test Plan walkthroughs for major system projects Coordinates testing and debugging of new or modified software Creates test matrices, trains, and provides supporting documentation Analyzes technical documentation to create test plan/matrices and updates statistical reporting software...

Summary Responsible for the accurate and timely processing of claims. Description 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...

Summary Under direct supervision, performs quality control audits, reviews, or monitoring of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies problems, analyzes cause and effect, and makes recommendations for improvements. Description Location This role is full time M-F 8am-5pm, onsite at our Florence, SC location. 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). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits...

Summary Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established standards and guidelines. Description Logistics: CGS (cgsadmin.com) – one of BlueCross BlueShield's South Carolina 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 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 26 Century Boulevard, Nashville, TN, 37214. 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...

Summary Assists in membership/enrollment, billing, collections, and/or customer service aspects for assigned department(s). Responsible for providing prompt, quality processing, enrollment, customer service, cash management activities, and administrative services for groups/agents, small groups, and/or policyholders. Description Logistics: This is a full-time, Monday–Friday position. Work hours vary between 8:00 a.m. and 6:00 p.m., with extended hours during open enrollment period and based on business needs. After initial training is completed onsite at the 4101 Percival Rd., Columbia, SC 29229 location and performance standards are met, the position will offer a hybrid work setting. What You Will Do: Assists management with verifying the accuracy and timeliness of workflow functions. Serves as liaison, coordinating with other departments as needed. Ensures compliance with all applicable laws and standards, and timely and accurate reporting to...

Summary Working at CGS Administrators CGS Administrators, LLC (CGS) is part of BCBSSC™'s Celerian Group of companies and provides a variety of services for Medicare beneficiaries, healthcare providers, and medical equipment suppliers in 38 states, supporting the needs of over 8.7 million Medicare beneficiaries and 103,000 healthcare professionals nationwide. This is an onsite full-time position located at 26 Century Blvd., Ste. ST610 Nashville, TN 37214-3685. If you have IT Business Analysis Healthcare experience and leadership capabilities, this could be the perfect role for you. Join a mission-driven organization making a national impact in healthcare. Be part of a collaborative, forward-thinking team where your work truly matters. Apply now and help shape the future of Medicare services. Position Purpose: Defines customer needs in technical and business contexts. Ensure the proposed technical and business solutions meet the customer's objectives for the work effort....

Summary Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Description PGBA – is a subsidiary company of BlueCross BlueShield of South Carolina. Location : This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility work any our 8-hour shift scheduled during hours of 10AM –7PM. Training will be Monday – Friday 8:00 AM - 4:30/5:00 PM for approximately 6-8 weeks. This role is located on site at 17 Technology Circle, Columbia SC 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...

Summary We have a job opening for the position of Summer Student Intern Accounting position at CGS one of BlueCross BlueShield of South Carolina subsidiary companies. The Intern position is utilized for training an active high school or college student towards an entry 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. The incumbent will work under direct supervision and will be responsible 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...

Summary Provides education and training support for network providers/staff/suppliers/physicians/beneficiaries/referral agents as necessary. Develops and produces training and educational materials. Description Position Purpose: 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...

Summary We are currently hiring for a Workforce and Reporting Manager to join BlueCross BlueShield of South Carolina. You will be responsible for managing one or more teams responsible for customer service. Manages the day-to-day operations and workload issues for staff. 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!...