Coordinator, Appeals

BlueCross BlueShield of South Carolina•Florence, SC

5d•Onsite

About The Position

Responsible for maintaining the proper flow of the request for appeals. Logistics: Palmetto GBA - one of BlueCross BlueShield's South Carolina subsidiary companies. SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. Work Setting: Onsite at 200 Dozier Blvd, Florence, SC 29501 OR 17 Technology Circle, Columbia, SC 29203 Working Hours: 8:00 AM – 4:30 PM (flexible after training)

Requirements

High School Diploma or equivalent
One year of administrative support/clerical or job-related experience.
Proficient in word processing and spreadsheet software: Microsoft Office
Organizational and customer service skills.
Good judgment skills.
Proficient in spelling, punctuation, grammar, written and verbal communication skills.

Nice To Haves

Skilled in using Excel.
Medical claims processing, appeals, insurance or healthcare experience.
Medicare experience

Responsibilities

Research requests, enter 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.
Ensure quality control of all appeals on the appeals system, pend documents to be saved electronically, and prepares case files for review and/or further routing.