Summary
 

Functions as work leader for a claims customer service unit responsible for resolving customer inquiries and performing initial claims adjudication or non-medical appeals review. Assists with escalated and complex issues.

Description
 

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. This role is located on-site at 4101 Percival Rd, Columbia, SC 29229. Training is from 8AM-4:30PM M-F. The work hours for this role can be between 8AM-6PM M-F.

What You’ll Do:

• Distribute daily work to employees, tracks workload and employee performance, and make appropriate decisions necessary to ensure all processing expectations and team goals are met.

• Respond accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals and other technical issues. Investigates and initiates resolutions to complex problems. Authorizes payment recovery, claim payments, or makes claim rejections based on documented information and provisions of state or federal law.

• Identify issues with procedures and processes and provide feedback to management on changes and development.

• Train new employees and introduce new material to all employees. Develops, updates, and maintains procedural manuals.

• Serve as liaison with other departments to address claim, system and quality issues. May perform some testing functions and attend/participate in meetings as needed.

• Customer Service Advocate Day-In-The-Life Video

To Qualify For This Position, You'll Need The Following:

• Required Education: High School Diploma or equivalent

• Required Work Experience: 3 years of customer service experience and 1 year of claims or appeals processing experience OR Bachelor’s Degree in lieu of work experience.

• Required Skills and Abilities: Excellent verbal and written communication skills. Strong customer service skills. Proficient spelling, punctuation, grammar, and basic business math. Ability to handle confidential or sensitive information with discretion. Knowledge of claims processing procedures.

• Required Software and Other Tools: Microsoft Office.

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.  

• Subsidized health plans, dental and vision coverage

• 401k retirement savings plan with company match

• Life Insurance

• Paid Time Off (PTO)

• On-site cafeterias and fitness centers in major locations

• Education Assistance

• Service Recognition

• National discounts to movies, theaters, zoos, theme parks and more

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 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.