Claims Coordinator

BlueCross BlueShield of South Carolina

5d•Remote

About The Position

Provides intake support for the claims department. Works with a team to coordinate communications and ensure emails are reviewed, assigned or responded to timely. Reviews claim submissions for accuracy and loads them into the claims system. Checks the status of claims and provides customer service to clients and partners. Experience with stop loss, third party administrator or medical claims preferred. Description Location: This is a full-time position working (40-hours/week) Monday-Friday 8:00am – 5:00pm working remotely. Position Purpose: Provides claims support by reviewing submissions, entering claims, tracking status, and responding to client and partner inquiries. Experience with stop loss, TPA, or medical claims preferred.

Requirements

High School Diploma or equivalent.
1 year customer service or administrative experience.
Excellent verbal and written communication skills.
Good human relations skills.
Strong research ability.
Ability to function in a high-pressure environment with minimum supervision.
Ability to handle confidential or sensitive information with discretion.
Strong organizational skills.
Proven customer service skills.
Good judgment.
Proficient spelling, punctuation, grammar, and basic math skills.
Microsoft Office.

Nice To Haves

Associate degree-Business Administration or related field
2 years-customer service, operations support, or underwriting experience.
Experience with stop loss, third party administrator or medical claims preferred.

Responsibilities

Processes mail, email and faxes to maintain departmental productivity, quality and timeliness standards.
May assist in preparing various financial data associated with refunds, recoupments, adjustments, and reissues, and ensure appropriate documentation for each refund request and associated payment.
Maintains logs.
Assists in processing/providing routine premium billing statements and/or various reports.
Maintains filing systems.
Coordinates communication of information between reinsurance companies and various internal and external areas.
Reviews documentation for completeness, and may rate new business, order required reports within timeliness standards, determine benefits, issue new policies, and/or report surplus lines taxes.
Requests additional information when needed within timeline standards.
Accurately documents process changes.
Checks status of claims or notices, and may service existing accounts by processing endorsements/amendments, identifying problems, and responding to inquiries.
May review disbursement requests for large case management claims and other specific diagnosis codes, and forward to claims for detailed review.
Ensures effective customer relations by responding accurately, timely, and courteously to telephone or written customer inquiries.
Accurately documents inquiries.