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
 

• 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.
• 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.
• Preferred Work Experience:
• 3 years-of related health or managed care industry work experience.
• 1 year-of management experience OR 1 year of equivalent military experience in grade E4 or above.
• Preferred Skills and Abilities:
• Ability to use complex mathematical calculations.
• Knowledge of mathematical or statistical concepts.
• Preferred Software and Other Tools:
• Proficient in database software.
• Work Environment:
• Typical office environment. Ability to travel as needed.

 

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.