BlueCross BlueShield of South Carolina

Compensation

Full Description

Summary Responsible for supporting and maintaining the coordination of daily operations of assigned area. Interfaces with the medical management on a regular basis to work more complex UR cases for the outpatient UR function. Description National Alliance – one of BlueCross BlueShield's South Carolina subsidiary companies. This position is full time (40 hours/week) Monday-Friday and will be fully remote (South Carolina W@H) One week of onsite training required at 4101 Percival Rd Columbia, SC 29229, followed by three weeks of remote training with the team What You'll Be Doing: This role is all about reporting! You'll be pulling data from multiple Blue Cross systems (Rumba, Blueview, Cohere) and creating detailed reports that summarize member healthcare spending and high-cost claims. It's a very structured, repetitive role—think consistent daily tasks with clear processes and deadlines. If you thrive on routine and accuracy, you'll do great here! Proficient in Excel (this is a must—you'll be working in spreadsheets daily!) Detail-oriented with strong written communication skills Self-motivated and excellent at time management What You Will Do: Maintains the outpatient authorization process to include ensuring benefit coverage, reviewing/determining eligibility, reviewing of established utilization review criteria, interpreting rules/regulations. Completes authorization by following established policies/procedures. Reviews interdepartmental requests and medical information to complete utilization process. Documents process used and decision in the appropriate system in accurate/timely manner. Establishes/maintains effective business relationships with primary care physician offices, other providers of health services. To Qualify for This Position, You Will Need: Graduate of Accredited School of Licensed Practical Nursing OR Licensed Vocational Nursing. Three years managed care in healthcare, physician's office, OR insurance company setting. Ability to work independently, prioritize effectively, and make sound decisions. Good judgment skills. Demonstrated customer service and organizational skills. Demonstrated oral and written communication skills. Ability to handle confidential OR sensitive information with discretion. Active, unrestricted LPN/LVN licensure from the United States and in the state of hire, OR active compact multistate unrestricted LPN license as defined by the Nurse Licensure Compact (NLC). Microsoft Office. What We Can Do for You 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 healthy lifestyle premium discount. Tuition assistance. Service recognition. Incentive Plan. Merit Plan. Continuing education funds for additional certifications and certification renewal. 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. If you don’t have an account with us and don’t see the dream job you are looking for, click on the link above to Join Our Talent Community by submitting your resume and contact information and we will reach out if we find a good fit. Welcome Here’s Your Smart Career Move 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. Business and political climates may change, but we’re stronger than ever. Our A.M. Best rating is A+ (Superior) — making us the only health insurance company in South Carolina with that rating. We’re 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! Veterans Welcome! BlueCross is a strong supporter of our veterans, and many service men and women have joined our ranks. We’ve found the dedication, work ethic and job skills that serve well in the military excel in many of our lines of business, and we proudly have veterans filling positions in Human Resources, Information Technology, Customer Service, Operations, General Services and more. Through our government contracts, we also have employees serving at Shaw Air Force Base, the Naval Health Clinic in Charleston, the Naval Hospital in Beaufort and in our hometown of Columbia, S.C., at Ft. Jackson. If you are a full-time employee in the National Guard or Reserves, we will even cover the difference in your pay if you are called to active duty. Join Us If you're ready to join in a diverse company with secure, community roots and an innovative future, apply for a position now!