Summary
 

Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

Description
 

Logistics​: This part-time (20 hours/week) position is available Monday through Thursday from 12:00 PM to 5:00 PM. It is onsite in Myrtle Beach, SC, reporting to our Surfside location.

What You’ll Do

• Research and responds to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.

• Research and respond to written inquiries and identify incorrectly processed claims and completes the adjustment and/or reprocessing action according to department guidelines. This may include initiating, documenting, and processing the request to completion. Initiate recoupments as necessary.

• Identify complaints and inquiries of a complexity level that cannot be resolved following desk procedures and guidelines and refer them to a lead or manager for resolution. Identify and report potential fraud and abuse situations.

• Complete projects and/or assignments related to the department's claims processing and customer service functions.

To Qualify for this Position, You’ll Need

• High School Diploma or equivalent

• Good oral and written communication skills.

• Strong customer service skills.

• Good spelling, punctuation, and grammar skills.

• Basic math proficiency.

• Ability to handle confidential and sensitive information with discretion.

• Microsoft Office.

• C2 Government clearance

We Prefer That You Have

• Two (2) years of customer service experience or one (1) year of claims or appeals processing experience and one year of customer service experience or bachelor's Degree in lieu of work experience.

• Prior TRICARE experience.

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 a recruiter to verify resume specifics and salary requirements.

 

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.