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
 

Position Purpose

This role is part of an inbound call center and directly helps our customers by responding to inquiries that may be non-routine and require deviation from standard screens, scripts and procedures.  Research may be required to resolve these inquiries.  Other responsibilities include review and adjudication of claims and/or non-medical appeals, determining whether to return, deny or pay claims while following policies and procedures.  

Logistics

This position is full-time (40 hours/week) Monday - Friday in a typical office environment. Employees are required to have the flexibility to work any of our 8-hour shift scheduled during our normal business hours of 7:30 AM EST - 5:00 PM EST. It may be necessary, given the business need, to work occasional overtime and weekends. This role is located at 4101 Percival Road, Columbia SC.

What You'll Do: 

• You'll ensure effective customer relations by responding accurately, timely and courteously to our customers.  These responses may be by telephone, written, web or walk-in inquiries.  You will handle situations which may require a different set of responses or extensive research.  Adhering to department guidelines, you will also identify claims that have been incorrectly processed and will enact process adjustments and reprocessing actions.
• You will examine and process claims and/or non-medical appeals while ensuring business/contract regulations, internal standards and examining guidelines.  Another responsibility is to enter claims into the claim system after verifying correct coding of procedures and diagnosis codes.  Claims must be processed according to established quality and production standards.
• You'll identify complaints and inquiries that my be complex and that cannot be resolved following usual procedures and guidelines and refer to a team lead or manager for resolution.  You will also identify and report fraud and abuse situations.

To Qualify for This Position, You'll Need: 

• A High School Diploma or equivalent. 
• Two years of customer service experience, including one year of claims or appeals processing OR an undergraduate degree in lieu of work experience.  
• Good verbal and written communication skills.
• Strong customer service skills.
• Good spelling, punctuation and grammar skills.
• Basic business math proficiency.  
• The ability to handle confidential or sensitive information with discretion.
• Knowledge of Microsoft Office applications.

What We Can Do For You:

You are not alone. We are here to support you:

30 days of classroom and training lab, including

• Best-in-class call center training program.
• A classroom environment, live trainer and open discussion.
• A proven curriculum providing the knowledge you need to excel.
• After the initial 30 days of training, there will be a two-week training lab where you take live calls with a trainer or manager close by to answer questions.

Our comprehensive benefits package includes:

• 401(k) retirement savings plan with company match.
• Subsidized 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, with prioritization given 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.