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 whether to return, deny or pay claims following organizational policies and procedures.

Description
 

Logistics:

This position is full time (40 hours/week) Monday-Friday located at 4101 Percival Rd, Columbia, SC 29229

What You’ll Do:

• Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.

• Handle situations which may require adaptation of response or extensive research.

• Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.

• Examine and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.

• Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.

• Ensure claims are processing according to established quality and production standards.

• Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution.

• Identify and reports potential fraud and abuse situations.

                      

To Qualify for This Position, You’ll Need:

• High School Diploma or equivalent.

• 2 years of customer service experience including 1 year claims OR appeals processing OR Bachelor's Degree in lieu of work experience

• Good verbal and written communication skills

• Strong customer service skills

• Good spelling, punctuation and grammar skills

• Basic business math proficiency

• Ability to handle confidential or sensitive information with discretion

What Blue Can Do For You:

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match

• Subsidized health plans and free vision coverage

• Life insurance

• Paid annual leave — the longer you work here, the more you earn

• Nine paid holidays

• On-site cafeterias and fitness centers in major locations

• Wellness programs and a healthy lifestyle premium discount

• Tuition assistance

• Service recognition

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.  Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.

 

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Some states have required notifications. Here's more information. 

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 minorities, females, disabled individuals and 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