Company · 288 open roles
Careers at Ourhrconnect
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288 positions at Ourhrconnect
Accountant I
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 …
RN Medical Reviewer II - Palmetto GBA
Ourhrconnect·W@H South Carolina
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…
Customer Service Advocate II
Ourhrconnect·Columbia, South Carolina
Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description Location: This posit…
Appeals Coordinator
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…
Operations Manager-2
Ourhrconnect·Florence, South Carolina
Summary Manages the daily activities of a multi-functional area. Responsible for monitoring productivity, attendance and quality of work produced. Responsible for motivating associates to meet individual and departmental goals. Description Why should you join the BlueCross Bl…
Developer IV - CGS Administrators, LLC (Nashville, TN)
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…
Claims Processor I - PGBA
Ourhrconnect·Florence, South Carolina
Summary We are currently hiring for a Claims Processor I to join BlueCross BlueShield of South Carolina. You will be responsible for the accurate and timely processing of claims. Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companie…
Analyst, Stop Loss Accounting
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 …
Senior Quality Assurance Analyst
Ourhrconnect·Myrtle Beach, South Carolina
Summary Performs quality control audits to evaluate accuracy and effectiveness of departmental operations functions including, but not limited to, claims, membership, customer service/call center, workflow, processing support systems, procedures, documentation, etc. Identifies …
Quality Assurance Analyst
Ourhrconnect·Florence, South Carolina
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. …
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 …
Processor, Claims I
Ourhrconnect·Myrtle Beach, South Carolina
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 8:00am-5:00pm in a typical office e…
Financial Analyst
Ourhrconnect·Columbia, South Carolina
Summary Extracts and reports enrollment and financial data used to develop competitive rates to achieve financial targets and reach profitability goals. Description Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go…
Appeals Specialist
Ourhrconnect·Nashville, Tennessee
Summary We are currently hiring a Part A/HHH Appeals Specialist at one of our subsidiary companies called CGS Administrators. CGS has been a proven provider of administrative and business services for state Medicaid agencies, managed care organizations, commercial health plans,…
Quality Assurance Manager
Ourhrconnect·Florence, South Carolina
Summary Oversees the conducting of operational audits, which provide verification of operating procedures and the development of quality control processes. Ensures compliance with all company directives and requirements. Description Location: This role is full time M-F 8am-5p…
Coordinator, Managed Care II/UM-1
Ourhrconnect·W@H South Carolina
Summary Reviews and evaluates medical or behavioral eligibility regarding benefits and clinical criteria by applying clinical expertise, administrative policies, and established clinical criteria to service requests or provides health management program interventions. Utilizes …
Customer Service Advocate I
Ourhrconnect·Nashville, Tennessee
Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Performs research as needed to resolve inquiries. Description Logistics: CGS - One of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is full-ti…
Quality Medical Auditor
Ourhrconnect·Columbia, South Carolina
Summary Performs validation reviews of Diagnosis Related Groups (DRG), Ambulatory Procedure Codes (APC), and Never Events (serious, preventable medical errors) for all lines of business. Coordinates rate adjustments with claims areas. Provides monthly and quarterly reports outl…
Representative, Enrollment I
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…
Benefit Files Analyst I
Ourhrconnect·Columbia, South Carolina
Summary Under general supervision, responsible for interpreting, reviewing, and analyzing benefit plan designs. Responsible for creating scope, design and specification documents for programming of benefits from benefit plan designs. Responsible for programming and / or auditin…
Benefit Files Analyst I
Ourhrconnect·Columbia, South Carolina
Summary Under general supervision, responsible for interpreting, reviewing, and analyzing benefit plan designs. Responsible for creating scope, design and specification documents for programming of benefits from benefit plan designs. Responsible for programming and / or auditin…
Claims Processor I
Ourhrconnect·Myrtle Beach, South Carolina
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 8:00am-5:00pm in a typical office e…
Solutions Manager - Hybrid Columbia, South Carolina
Ourhrconnect·Columbia, South Carolina
Summary Leads solutions management across the healthcare continuum, including clinical, pharmacy, wellness, and ancillary offerings. Oversees a team of Wellbeing Consultants and ensures effective sales enablement, retention strategies, and service delivery to achieve growth and…
Customer Service Advocate II
Ourhrconnect·Columbia, South Carolina
Summary Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Description Location: This posit…