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
 

Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. This role is located on-site at 2743 Perimeter Parkway Augusta, GA 30909.

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 process 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 processed 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 refer these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations.

To Qualify For This Position, You'll Need The Following:

• Required Education: High School Diploma or equivalent

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

• Required Software and tools: Microsoft Office.

• Required Skills and Abilities: 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.

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

• Education Assistance

• Service Recognition

• National 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 our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross