Summary
Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically 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 complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.
Location:
This position is full-time (40 hours/week) Monday through Friday in a typical office environment or home environment. You will work an 8-hour shift 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. This role is located on-site at 4101 Percival Road, Columbia, SC . Training will be onsite Monday-Friday 8:00 AM -4:30PM for approximately 8-10 weeks.
Sponsorship : This position is not eligible for sponsorship now or in the future.
What You’ll Do:
Responsible for accurate and timely response to complex telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Maintain all departmental productivity, quality and timeliness standards.
Initiate corrective actions, process adjustments, or perform other research to resolve inquiries. Evaluate inquiries to identify underlying causes and implement actions to prevent future issues. Coordinate with other departments to resolve problems.
Provide feedback to management regarding customer issues. Maintain accurate records concerning issues. Follow through on inquiries until resolved or report to management as needed.
Maintain knowledge of procedures and policies. Assist with process improvements by recommending improvements in procedures and policies.
Assist with the training of new employees and cross training of coworkers.
To Qualify for This Position, You'll Need the Following:
Required Education:
High School Diploma or equivalent
Required Work Experience:
2 Years Customer service or claims processing experience OR Bachelor's Degree in lieu of work experience.
Required Skills and Abilities:
Strong oral and written communication skills.
Proficient in spelling, punctuation, and grammar.
Strong organizational, analytical, and customer service skills.
Ability to handle high stress situations.
Basic business math proficiency.
Ability to handle confidential or sensitive information with discretion.
Ability to learn and operate multiple computer systems effectively and efficiently.
Required Software and Other Tools:
Microsoft Office.
We Prefer You Have the Following :
Preferred Work Experience:
3 Years-Customer service or claims processing experience.
Preferred Education:
Associate Degree-Any Major
Preferred Skills and Abilities:
Ability to persuade, negotiate or influence.
Preferred Software and Other Tools :
Knowledge of database software.
Our comprehensive benefits package…