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
 

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 insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

In the role as the Claims Customer Service Coordinator, the ideal candidate will function as a work leader for a claim’s customer service unit, responsible for coordinating information between management and customer service advocates (CSA), resolving customer inquiries, and performing initial claims adjudication or non-medical appeals review. The ideal candidate will also assist with escalated and complex issues.

Logistics:

This position is full-time position (40 hours per week) Monday through Friday 7:30am-4:00 pm or 8:00am – 4:30pm reporting onsite to 4101 Percival Road Columbia, SC 29219   

What You'll Do:

• Distributes daily work to employees, tracks workload and employee performance, and makes appropriate decisions necessary to ensure all processing expectations and team goals are met.
• Responds 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.
• Identifies issues with procedures and processes and provides feedback to management on changes and development.
• Trains new employees and introduces new material to all employees. Develops, updates, and maintains procedural manuals.
• Serves as liaison with other departments to address claim, system and quality issues. May perform some testing functions and attend/participate in meetings as needed.

To Qualify for This Position:

• High School Diploma or equivalent
• 3 years of customer service experience and 1 year of claims or appeals processing experience OR Bachelor’s Degree in lieu of work experience.
• 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.
• Microsoft Office.

We Prefer That You Have:

• Claims experience.
• Ability to process claims and medical records.
• Reporting and delegation experience.
• Training experience.
   

What We can Do for You:

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 Ins