Summary
 

Responsible for the management of assigned claims operation(s) to ensure that investigation and adjudication of claims meet established performance standards and objectives. Position may be assigned to multiple lines of business, contracts, and specialty claims operations.

Description
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, 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, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose: Responsible for the management of assigned claims operation(s) to ensure that investigation and adjudication of claims meet established performance standards and objectives. Position may be assigned to multiple lines of business, contracts, and specialty claims operations.

Logistics: Planned Administrators Inc. (PAI) - one of BlueCross BlueShield's South Carolina subsidiary companies.

Location: This is a full-time position, with a Hybrid schedule**, working an 8-hr. shift (40-hours/week) Monday-Friday 8:00am – 4:30pm with primary location at 17 Technology Circle Columbia SC, Columbia, SC 29203. **Due to the hybrid nature of the schedule, qualified, local candidates need apply.

Sponsorship: This position is not eligible for sponsorship, now or in the future.

What You'll Do:

• Provides management and oversight of claims to ensure performance standards are maintained including investigation and adjudication of claims, file documentation and management, reserving practices, pursuit of recovery and other account specific or contractual requirements.

• Develops and maintains effective working relationships with external business partners to include insureds, agents, self-insured clients, vendors, defense firms, and other business partners for assigned lines of business, contracts or specialty claims operations. Responsible for development and maintaining effective working relationships with other operational and support areas.

• Responsible for development of claims staff, vendors, and contractors to ensure quality claims handling and outcomes. May include identification of training needs, implementation of educational programs, process changes, performance management, and audit functions.

• Completes requests for proposal, bids, and due diligence efforts on potential new jurisdictions, contracts, or specialty claims programs. Responsible for effective implementation and management of new business opportunities.

• Assists claims senior management team in achieving both departmental and corporate strategies and goals.

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

• Required Education: Bachelor's degree (see degree equivalency below)

• Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience.

• Required Work Experience: 2 years of area related adjusting experience.

• Required Training: Valid adjustor's license in required states or ability to acquire within 6 months-if required by the resident state's department of insurance.

• Skills and Abilities: Analyzes laws, regulations and contract language. Evaluates issues and develops recommendations. Handles confidential and sensitive information. Investigates assigned claims. Proposes claims adjustments and refunds. Works claims caseloads.

We Prefer That You Have the Following:

• Preferred Experience: Prior management experience directly related to position assignment (i.e. WC, Liability, TPA, or specialty operations).