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
 

Logistics:

• You will be required to attend eight weeks training at 4101 Percival Road in Columbia, SC. Training hours are 8:00 am to 4:30 pm Monday through Friday.

• Following training, work hours will be 9:30 am to 6:00 pm Monday through Friday.

What You Will Do:

• Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Accurately documents inquiries.

• Initiates or processes adjustments or performs other research as needed to resolve inquiries. Coordinates with other departments to resolve problems. Responds to, researches and/or assists with priority inquiries and special projects as required by management.

• Provides feedback to management regarding customer problems, questions and needs. Maintains accurate records on complaints and/or other customer comments, and makes recommendations for changes to management. Follows through on complaints until resolved or reports to management as needed.

• Maintains basic knowledge of quality work instructions and company policies. Assists with process improvements through the recommendation of changes in procedures and techniques discovered during daily operations. Maintains all departmental productivity, quality, and timeliness standards.

• Assist with the training of new employees and cross training of coworkers.

What You Need to Qualify:

• Required Education: High School Diploma or equivalent

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

• Required Skills and Abilities: Excellent verbal and written communication skills. Proficient spelling, punctuation, and grammar. Strong human relations and organizational skills. Ability to handle high stress situations. Good judgment. Ability to handle confidential or sensitive information with discretion. Ability to learn and operate multiple computer systems effectively and efficiently.

• Required Software and Tools: Basic computer operating skills. Standard office equipment.

What We Prefer You Have:

• Medical office, insurance, healthcare or call center experience.

• Experience handling complex or escalated customer service issues.

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 access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match

• Fantastic health plans and free vision coverage

• Life insurance

• Paid annual leave — the longer you work here, the more you earn

• Nine paid holidays

• On-site cafeterias and fitness centers in major locations

• Wellness programs and a healthy lifestyle premium discount

• Tuition assistance

• Service recognition

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. Management will be conducting interviews with the most qualified candidates.

 

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.