Company · 197 open roles
Careers at Ourhrconnect
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197 positions at Ourhrconnect
Training Specialist II (PGBA)
Ourhrconnect·Florence, South Carolina
Summary Responsible for identifying training needs, developing training materials and facilitating training. Provides training, guidance and leadership for new training specialists. Develops performance assessments and testing materials. Manages trainees and communicates effect…
Technician, Accounting II-CGS
Ourhrconnect·Nashville, Tennessee
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…
Senior AI Security Architect
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 largest…
Accounting Technician II
Ourhrconnect·Columbia, South Carolina
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 …
Quality and Risk Performance Officer, Medicare Advantage
Ourhrconnect·Columbia, 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 large…
Payment Integrity Nurse – Medicare Advantage
Ourhrconnect·W@H South Carolina
Summary We are currently hiring for a Payment Integrity Nurse – Medicare Advantage to join BlueCross BlueShield of South Carolina. In this role as an Payment Integrity Nurse, you will monitor/implement quality improvement/management activities, conduct specific medical reviews …
Manager, Underwriting
Ourhrconnect·Columbia, South Carolina
Summary Oversees the day-to-day underwriting operations including budget and staff planning as well as direct supervision of personnel to successfully accomplish company underwriting objectives and compliance. Identifies, analyzes, and manages the assigned line of business for …
Manager, Medical Review (Medicare - Appeals; Utilization Review; Part A; HHH)
Ourhrconnect·W@H Tennessee
Summary Oversees the accurate processing of claims that have been deferred for medical necessity review. Ensures compliance with nationally recognized standards, and local, state, and federal laws and regulations. Identifies and implements process improvement opportunities. Des…
Developer- CGS Administrators, LLC
Ourhrconnect·Nashville, Tennessee
Summary 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 beneficiar…
Behavioral Health Medical Director
Ourhrconnect·W@H 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 large…
Training Specialist II
Ourhrconnect·Columbia, 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…
Assistant, Qualified Independent Contractor
Ourhrconnect·Nashville, Tennessee
Summary Provides all redetermination case file information within the specified time requirement while maintaining accuracy and departmental standards. Suspends claims in applicable claim system and tracks all data. Description Logistics CGS one of BlueCross BlueShield's Sou…
Utilization Management Pharmacist
Ourhrconnect·Columbia, South Carolina
Summary Responsible for performing comprehensive medication reviews and outreach to inform and educate patients and their providers about opportunities to optimize medication related outcomes, ensure patient safety, and utilize cost effective therapies. Collaborates with other …
Pharmacy Technician - Prior Authorization Focus
Ourhrconnect·Columbia, South Carolina
Summary Responsible for setting up cases for pharmacy authorization requests and performing pharmacy reviews as per established criteria. Maintains the timely, complete, and accurate processing of authorization requests by interfacing with internal and external customers and th…
Manager, Contract Compliance
Ourhrconnect·Columbia, South Carolina
Summary Responsible for the implementation and oversight of a comprehensive compliance program that meets all regulatory requirements for commercial and/or government programs products. Oversees federal and state regulatory compliance activities, regulatory filings, and contrac…
Accountant III-CDS
Ourhrconnect·Columbia, South Carolina
Summary 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…
Sr Stoploss Claim Auditor-2
Ourhrconnect·Jacksonville, Florida
Summary Audit and authorize reimbursement of specific medical stop loss claims. Effectively mitigate client medical stop loss claims and provide excellent customer service. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come…
Corporate Investigator I
Ourhrconnect·Columbia, South Carolina
Summary Responsible for investigating allegations of fraud/abuse against company and to resolve these allegations through recovery of monies paid improperly as a result of fraud and abuse or billing errors, and to refer fraudulent providers or subscribers to law enforcement for…
Telemarketing Associate - Onsite, Columbia, SC
Ourhrconnect·Columbia, South Carolina
Summary Sells insurance products through telemarketing. Description Location: This position is onsite 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…
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…
Telemarketing Representative Medicare Sales - Onsite Columbia, South Carolina
Ourhrconnect·Columbia, South Carolina
Summary Sells Medicare insurance products through telemarketing. Description Location: This position is onsite 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. I…
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…