Company · 288 open roles
Careers at Ourhrconnect
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288 positions at Ourhrconnect
Appeals Specialist (CGS Admin)
Ourhrconnect·W@H Wake County, NC
Summary We are currently hiring for an Appeals Specialist to join BlueCross BlueShield of South Carolina. In this role as Appeals Specialist, you will be required to perform non-medical reviews and process redetermination letters. Why should you join the BlueCross BlueShield o…
RN Medical Reviewer II
Ourhrconnect·W@H Tennessee
Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or clinical guidelines. Provides support and review of medical c…
Case Management Coordinator (RN or Social Worker)
Ourhrconnect·W@H South Carolina
Summary We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coordination and reducing the fragmentation of the services the…
Claims Customer Service Advocate II
Ourhrconnect·Myrtle Beach, South Carolina
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 • 60% Researches and responds to telephone in…
Specialist, Appeals
Ourhrconnect·Florence, South Carolina
Summary 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…
Regional Sales Director - Greenville, SC/Hybrid
Ourhrconnect·Greenville, South Carolina
Summary Leads the sales, renewal, and service operations for the assigned region, driving growth, customer retention, and market expansion. Provides strategic leadership to a high-performing team while fostering and strengthening long-term relationships with customers and key s…
Claims Customer Service Advocate II
Ourhrconnect·Columbia, South Carolina
Summary Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines w…
FCMB Claims Customer Service Advocate II
Ourhrconnect·Columbia, South Carolina
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 Logistics: PGBA – is a subsidiary company of …
Senior Administrative Associate
Ourhrconnect·Columbia, South Carolina
Summary Provides daily professional administrative, clerical, and project coordination support. Maintains area files, correspondence, reports, and other documentation. Coordinates, completes, and delivers required reporting. Tasks are varied and usually require area specific kn…
Customer Service Advocate III
Ourhrconnect·Columbia, South Carolina
Summary Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description Locat…
Strategic Sales Representative
Ourhrconnect·W@H South Carolina
Summary Responsible for the successful marketing (sales, renewals, and/or service) of group and/or individual accounts for products as defined by production quotas within assigned territory. Customarily and regularly engaged in outside sales. Description Location: This positi…
Part - Time Claims Processor I
Ourhrconnect·Columbia, South Carolina
Summary Responsible for the accurate and timely processing of claims. Description Location: This position is part-time (30-hours/week) Monday-Friday from 8am-2:30pm in a typical office environment. The role is located on-site at 4101 Percival Rd, Columbia, SC 29229. What You…
Specialist, Provider File I
Ourhrconnect·Florence, South Carolina
Summary 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. Why should you join the BlueCross BlueSh…
Provider File Specialist I
Ourhrconnect·Myrtle Beach, South Carolina
Summary 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. Description Logistics: PGBA – one of Bl…
Operations Analyst
Ourhrconnect·Columbia, South Carolina
Summary Under general supervision, analyzes proposed policies, procedures, forms, and reports. Recommends operational improvement through standardization, simplification, discontinuance and other methods. Recommends installations of new systems/procedures. Reviews organizationa…
Operation Manager - Palmetto GBA
Ourhrconnect·Columbia, South Carolina
Summary Palmetto GBA is one of the nation’s largest providers of high-volume claims and transaction processing, contact center operations, and technical services to the federal government and other commercial customers. Our core business is providing services to CMS Medicare be…
Managed Care Coordinator II - Oncology Focus
Ourhrconnect·W@H South Carolina
Summary Care management interventions focus on improving care coordination and reducing the fragmentation of the services the recipients of care often experience, especially when multiple health care providers and different care settings are involved. Taken collectively, care m…
Technician, Accounting III
Ourhrconnect·Nashville, Tennessee
Summary 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 …
RN Appeals Analyst
Ourhrconnect·Nashville, Tennessee
Summary Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the requested services meet medical necessity guidelines. Documen…
Quality Nurse Navigator (RN or LPN)
Ourhrconnect·Columbia, South Carolina
Summary We are currently hiring for a Quality Nurse Navigator to join BlueCross BlueShield of South Carolina. In this role as a Quality Nurse Navigator, you will monitor/implement quality improvement/management activities, conduct specific medical reviews as necessary, analyze …
IT Project Manager - PGBA
Ourhrconnect·Columbia, South Carolina
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 larges…
Client Relationship Manager II - Hybrid Columbia, SC
Ourhrconnect·Columbia, South Carolina
Summary First 60 days this position is onsite. After 60 days, incumbent will have remote Friday's. Ultimately the goal is to reach two days remote. Account management and healthcare experience strongly preferred. Serves as the day-to-day lead in the client issues, service re…
Statistical Programming Analyst I- Palmetto GBA
Ourhrconnect·Columbia, South Carolina
Summary Job Description Summary Palmetto GBA is one of the nation’s largest providers of high-volume claims and transaction processing, contact center operations, and technical services to the federal government and other commercial customers. Our core business is providing ser…
Entry Level Cost Auditor
Ourhrconnect·Springfield, Illinois
Summary Responsible for assisting in the execution of financial, compliance, and operational audits including evaluation of internal controls. Audits the activity of various departments and providers for compliance with plans, policies, and procedures prescribed by management. …