Claims Customer Service Coordinator

Summary

Functions as work leader for a claims customer service unit responsible for resolving customer inquiries and performing initial claims adjudication or non-medical appeals review. Assists with escalated and complex issues.

Description

Logistics:

This position is full time (40 hours/week) Monday-Friday. The hours of operation are between 8AM and 5PM and will be located at 4101 Percival Road, Columbia S.C., 29219. Remote possibility will be dependent on Management evaluation. You will have to work on site as needed if remote access is granted.

What You Will Do

• Identifies issues with procedures and processes and provides feedback to management on changes and development.
• Trains new employees and introduces new material to all employees. Develops, updates, and maintains procedural manuals.
• Serves as liaison with other departments to address claim, system and quality issues. May perform some testing functions and attend/participate in meetings as needed.
• Distributes daily work to employees, tracks workload and employee performance, and makes appropriate decisions necessary to ensure all processing expectations and team goals are met.
• Responds accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals and other technical issues. Investigates and initiates resolutions to complex problems. Authorizes payment recovery, claim payments, or makes claim rejections based on documented information and provisions of state or federal law.

Required Work Experience

• 3 years of customer service experience and 1 year of claims or appeals processing experience OR Bachelor’s Degree in lieu of work experience.

Required Education

• High School Diploma or equivalent

Required Skills And Abilities

• Excellent verbal and written communication skills. Strong customer service skills. Proficient spelling, punctuation, grammar, and basic business math. Ability to handle confidential or sensitive information with discretion. Knowledge of claims processing procedures.

Required Software And Other Tools

• Microsoft Office.

What We Can Do For You

• Service recognition
• Merit Plan
• On-site cafeterias and fitness centers in major locations
• Subsidized health plans and free vision coverage
• Continuing education funds for additional certifications and certification renewal
• Paid annual leave – the longer you work here, the more you earn.
• Life insurance
• Wellness programs and healthy lifestyle premium discount
• Nine paid holidays
• Tuition assistance
• 401(k) retirement savings plan with company match
• Incentive Plan

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.

Management will be conducting interviews with those candidates who qualify, 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.

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. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.