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. Employees are required to have flexibility to work our 8-hour shift scheduled during the hours of 8:00 AM –4:30 PM. There is a possibility of overtime. Training will be Monday – Friday 8:00 AM to 4:30 PM for 6-8 weeks. This role is located on site at 4101 Percival Road, Columbia SC.

What You will 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, you will Need:

• High School Diploma or equivalent
• 3-years of customer service experience and 1-year of claims or appeals experience OR bachelor’s degree in lieu of work experience.
• Excellent verbal and written communication skills.
• Strong customer service skills.
• Proficient spelling, punctuation, and grammar skills.
• Basic business math abilities.
• Ability to handle confidential or sensitive information with discretion.
• Knowledge of claims processing procedures.
• 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
• Wellness program and healthy lifestyle premium discount
• Tuition assistance
• Service recognition
• Employee Assistance
• 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 a recruiter to verify resume specifics and salary requirements.