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Specialist, Provider File I

May 5, 2026

<h1> Summary </h1>Responsible for establishing and maintaining certification and/or preparation, review and/or maintenance of healthcare provider files in support of provider directories, accurate/timely claims adjudication, and provider billing.<h1> Description </h1>Logistics: <a href="https://pgba.com/" target="_blank" rel="noopener noreferrer">PGBA</a> – one of BlueCross BlueShield's South Carolina subsidiary companies.Location: This position is full-time (40-hours/week) Monday-Friday. Work for this position can be performed onsite or remotely. Onsite work will be performed at 8733 Highway 17 Bypass S, Myrtle Beach, SC, 29575. 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.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). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.What You’ll Do:<ul><li>Verifies necessary/needed information (written notifications, faxes, emails, or telephone contacts) and/or establishes certification of healthcare service providers.</li><li>Prepares provider files/maintains provider data (updates, additions, deletions) on the provider information management system (PIMS) or appropriate provider system/database.</li><li>Identifies/assigns providers to the appropriate network and provider system/database.</li><li>Contributes to department's production standard by working on PIMS and AMMS (automated medical management systems) or appropriate provider system/database maintenance/error reports.</li><li>Contributes to and participates on special projects, which may include but are not limited to the following: mass rate updates, quality improvement, audits, etc. </li></ul>To Qualify for This Position, You’ll Need the Following:<ul><li>Required Education: High School Diploma or equivalent.</li><li>Required Work Experience: 1 year of administrative/clerical support, customer service, claims processing, and/or provider network/certification experience.</li><li>Required Skills and Abilities: Working knowledge of word processing and spreadsheet software. Knowledge/understanding of or ability to acquire PIMS. Good judgment skills. Effective customer service and organizational skills. Demonstrated verbal and written communication skills. Basic business math proficiency. Ability to handle confidential or sensitive information with discretion.</li><li>Required Software and Tools: Microsoft Office.</li></ul>We Prefer That You Have the Following:<ul><li>Preferred Software and Other Tools: Ability to learn DB2, SQL language to create/run PIMS queries for QC/research purposes. </li></ul>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. <ul><li>Subsidized health plans, dental and vision coverage</li><li>401k retirement savings plan with company match</li><li>Life Insurance</li><li>Paid Time Off (PTO)</li><li>On-site cafeterias and fitness centers in major locations</li><li>Education Assistance</li><li>Service Recognition</li><li>National discounts to movies, theaters, zoos, theme parks and more</li></ul>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 StatementBlueCross 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 <a href="mailto:mycareer.help@bcbssc.com" target="_blank" rel="noopener noreferrer">mycareer.help@bcbssc.com</a> 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 <a href="https://www.southcarolinablues.com/web/public/resources/c4cb28a0-f717-4f26-8270-abae70243be7/Everify_EEO+2019.pdf?MOD=AJPERES&CVID=mKvY6R0" target="_blank" rel="noopener noreferrer">more information</a><a href="https://www.southcarolinablues.com/web/public/resources/c4cb28a0-f717-4f26-8270-abae70243be7/Everify_EEO+2019.pdf?MOD=AJPERES&CVID=mKvY6R0" target="_blank" rel="noopener noreferrer">.</a>Some states have required notifications. Here's <a href="https://www.southcarolinablues.com/web/public/resources/cf014797-0b05-46c2-ab33-ec3a1bf9864a/California+Notice+to+Applicants_.pdf?MOD=AJPERES&CVID=oJErh8p" target="_blank" rel="noopener noreferrer">more information</a>.

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Common Interview Questions And Answers

1. HOW DO YOU PLAN YOUR DAY?

This is what this question poses: When do you focus and start working seriously? What are the hours you work optimally? Are you a night owl? A morning bird? Remote teams can be made up of people working on different shifts and around the world, so you won't necessarily be stuck in the 9-5 schedule if it's not for you...

2. HOW DO YOU USE THE DIFFERENT COMMUNICATION TOOLS IN DIFFERENT SITUATIONS?

When you're working on a remote team, there's no way to chat in the hallway between meetings or catch up on the latest project during an office carpool. Therefore, virtual communication will be absolutely essential to get your work done...

3. WHAT IS "WORKING REMOTE" REALLY FOR YOU?

Many people want to work remotely because of the flexibility it allows. You can work anywhere and at any time of the day...

4. WHAT DO YOU NEED IN YOUR PHYSICAL WORKSPACE TO SUCCEED IN YOUR WORK?

With this question, companies are looking to see what equipment they may need to provide you with and to verify how aware you are of what remote working could mean for you physically and logistically...

5. HOW DO YOU PROCESS INFORMATION?

Several years ago, I was working in a team to plan a big event. My supervisor made us all work as a team before the big day. One of our activities has been to find out how each of us processes information...

6. HOW DO YOU MANAGE THE CALENDAR AND THE PROGRAM? WHICH APPLICATIONS / SYSTEM DO YOU USE?

Or you may receive even more specific questions, such as: What's on your calendar? Do you plan blocks of time to do certain types of work? Do you have an open calendar that everyone can see?...

7. HOW DO YOU ORGANIZE FILES, LINKS, AND TABS ON YOUR COMPUTER?

Just like your schedule, how you track files and other information is very important. After all, everything is digital!...

8. HOW TO PRIORITIZE WORK?

The day I watched Marie Forleo's film separating the important from the urgent, my life changed. Not all remote jobs start fast, but most of them are...

9. HOW DO YOU PREPARE FOR A MEETING AND PREPARE A MEETING? WHAT DO YOU SEE HAPPENING DURING THE MEETING?

Just as communication is essential when working remotely, so is organization. Because you won't have those opportunities in the elevator or a casual conversation in the lunchroom, you should take advantage of the little time you have in a video or phone conference...

10. HOW DO YOU USE TECHNOLOGY ON A DAILY BASIS, IN YOUR WORK AND FOR YOUR PLEASURE?

This is a great question because it shows your comfort level with technology, which is very important for a remote worker because you will be working with technology over time...