Coordinator, Appeals

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Onsite

About The Position

The Appeals Coordinator role focuses on reviewing and screening appeals to ensure they are assigned to the correct document type, including researching requests, entering the appropriate data to identify case specifics, and building appeal cases in the system. This is a full-time position (40-hours/week, Monday – Friday, 8:00 am – 5:00 pm). This position requires CMS Security Clearance as it falls within a division subject to Centers for Medicare and Medicaid Services residency requirements. As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Your coverage begins on the first day of the month following 28 days of full-time employment. This position is not eligible for sponsorship now or in the future.

Requirements

High School Diploma or equivalent.
1 year administrative support/clerical or job related experience.
Demonstrated proficiency in word processing and spreadsheet software.
Effective organizational and customer service skills.
Good judgment skills.
Proficiency in spelling, punctuation, and grammar skills.
Demonstrated written and verbal communication skills.
Microsoft Office.

Nice To Haves

3 years-claims, customer service or healthcare program management.
Ability to persuade, negotiate, or influence.
Knowledge of Microsoft Access or other database software.

Responsibilities

Researches requests, enters appropriate data to identify case specifics and builds appeals cases on the system.
Logs requests to appropriate functional area, generates letters, assembles files, orders records and obtains additional information as directed.
Ensures quality control of all appeals on the appeals system, pends documents to be saved electronically, and prepares case files for review and/or further routing.