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
 

Logistics: PGBA– one of BlueCross BlueShield's South Carolina subsidiary companies

Location: This position is full-time (40 hours/week) Monday-Friday from 9:00am-6:00pm; Rotating once a month 10:00am-7:00pm or 11:00am-8:00pm. This role is located on-site at 17 Technology Circle, Columbia, SC 29203.

• Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. 

What You’ll Do: 

• Direct and supervise claims/documents processing and support team associates to ensure claims/documents are processed in a timely and efficient manner to maintain contract compliance standards. Prepare and analyze reports of pending and processed documents, claims, adjustments and reprocesses, and quality audits of claims/documents that measure level of performance of the team. Administer and oversee quality control procedures and ensure compliance of all corporate and contract required guidelines. Select and maintain a well-trained staff. Identify potential education and system issues.

• Establish and maintain a high level of customer service with all internal and external customers. Direct and supervise the customer service associates to ensure that all correspondence and telephone inquiries are processed in a timely and efficient manner to maintain contract compliance standards. Select and maintain a well-trained staff. Identify potential education and system issues.

• Participate as project leader on policy changes, quality improvements initiatives and system change efforts, while ensuring corporate, contractor, and department policies and procedures are administered timely, consistently and accurately. Identify system errors and process/quality improvement opportunities, initiate work requests, and serve as the customer project lead to ensure accurate implementation.

• Assist in budget preparation and monitor expenses related to the budget.

To Qualify for This Position, You'll Need the Following: 

• Required Education: Bachelor’s

• Required Work Experience: 3 years of job related work experience, including either 1 year of supervisory experience OR 1 year equivalent military experience in grade E4 or above.

• Required Skills and Abilities: 

• Strong management, organization, communication, decision-making, and analytical skills. 

• Excellent customer service skills. 

• Strong presentation skills and basic business math proficiency. 

• Knowledge of applicable laws and regulations pertaining to business unit operations.

• Required Software and Tools: Microsoft Office.

We Prefer That You Have the Following:

• Preferred Work Experience:

• 3 years-of related health or managed care industry work experience. 

• 3 years-of management experience OR 1 year of equivalent military experience in grade E4 or above.

• Tricare experience.

• Preferred Skills and Abilities: 

• Strong time management skills. 

• Good communication skills. 

• Preferred Software and Other Tools: Proficient database software skills. 

Our Comprehensive Benefits Package Includes the Following:

We offer our employees great benefits and rewards.  You will be eligible to participate in the benefits for 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