Summary
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.
Description
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!
Position Purpose :
Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.
Location:
This position is full-time (40 hours/week) Monday through Friday in a typical office environment. You will work an 8-hour sift scheduled during our normal business hours of 8:00 AM - 5:00 PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. Training will be onsite Monday-Friday 8:00 AM -5 PM for approximately 8-10 weeks. This role is located on-site at 4101 Percival Road; Columbia SC.
Sponsorship : This position is not eligible for sponsorship now or in the future.
What You’ll Do:
Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards.
Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.
To Qualify for This Position, You’ll Need the Following:
Required Education:
A High School Diploma or equivalent
Required Work Experience:
1-year of experience including 1-year claims/appeals processing, customer service, or other related support area OR bachelor’s degree in lieu of work experience.
Required Skills and Abilities:
Good Verbal and Written Communication Skills
Strong Customer Service Skills
Good Spelling, Punctuation and Grammar Skills.
Basic Business Math Proficiency.
Ability to Manage Confidential or Sensitive Information with Discretion.
Required Software and Tools:
Microsoft Office.
What We Prefer that you Have the Following:
Associate degree
(2) years-of claims processing or call center experience.
Knowledge of word processing, spreadsheet, and database software.
Our comprehensive benefits package includes the following :
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401K retirement savings plan with company match
Life Insurance
Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Wellness program and…