Summary
 

Oversees an area responsible for claims, appeals, and/or customer service to ensure departmental performance guarantees are met.

Description
 

Logistics:

This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 7:30am-4pm. You may be required to travel between buildings. This role is located at 4101 Percival Road, Columbia, SC 29203 and provides a typical office work environment. It may be necessary, given the business needs, to work occasional overtime.

What You’ll Do:

• Ensure prompt and accurate settlement of claims, appeals, and/or customer service inquiries. Coordinates with other areas while establishing and maintaining excellent customer relations.
• Analyze problems and concerns to make effective decisions that provide positive solutions. Make recommendations for process improvements and efficiencies for the department.
• Serves as a liaison for internal and external customers. Ensures the timely and accurate resolution of any issues and/or provides necessary training to staff as needed or requested.

To Qualify for This Position, You’ll Need:

• Bachelor's degree or 4 years of healthcare experience in customer service, provider network service, membership, billing, and/or claims/appeals processing operations OR Four years of healthcare experience in customer service, provider network service, membership, billing, and/or claims/appeals processing operations.
• Two (2) years of claims/appeals, customer service, or call center experience.
• Answers phones
• Follows policies and procedures.
• Navigates systems.
• Processes claims.
• Research inquiries
• Reviews claims and appeals.
• Microsoft Office.

What we Prefer:

• National Alliance Experience
• 4 years-of healthcare, customer service, or claims experience.
• Previous budget experience.
• Previous appeals experienc
• 1 year-of leadership experience including scheduling or coordinating work of others, developing work procedures and training for others, and/or leading group project initiatives.
• Strong presentation skills. Basic business math skills.
• Ability to interact easily with customers, staff, and other members of the organization. Knowledge of the benefit plans for each group.
• Knowledge of all systems and their roles in claims adjudication.
• Strong leadership skills to direct and motivate employees.
• Knowledge of performance standards and quality assurance guidelines

What We can Do for You:

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 to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications.  This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications required proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, with prioritization give 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 providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.