Coordinator, Claims Customer Service

BlueCross BlueShield of South Carolina•Columbia, SC

8d•Onsite

About The Position

Functions as work leader for a claims customer service unit responsible for resolving customer inquiries and performing initial claims adjudication or non-medical appeals review. Assists with escalated and complex issues. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. This role is located on-site at 4101 Percival Rd, Columbia, SC 29229 What You’ll Do: Distribute daily work to employees, tracks workload and employee performance, and make appropriate decisions necessary to ensure all processing expectations and team goals are met. Respond accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals and other technical issues. Investigates and initiates resolutions to complex problems. Authorizes payment recovery, claim payments, or makes claim rejections based on documented information and provisions of state or federal law. Identify issues with procedures and processes and provide feedback to management on changes and development. Train new employees and introduce new material to all employees. Develops, updates, and maintains procedural manuals. Serve as liaison with other departments to address claim, system and quality issues. May perform some testing functions and attend/participate in meetings as needed. Location: This position is full-time (40-hours/week) Monday-Friday in a typical office environment. This role is located on-site at 17 Technology Circle Columbia, SC 29203 What You’ll Do: Distribute daily work to employees, tracks workload and employee performance, and make appropriate decisions necessary to ensure all processing expectations and team goals are met. Respond accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals and other technical issues. Investigates and initiates resolutions to complex problems. Authorizes payment recovery, claim payments, or makes claim rejections based on documented information and provisions of state or federal law. Identify issues with procedures and processes and provide feedback to management on changes and development. Train new employees and introduce new material to all employees. Develops, updates, and maintains procedural manuals. Serve as liaison with other departments to address claim, system and quality issues. May perform some testing functions and attend/participate in meetings as needed.

Requirements

High School Diploma or equivalent
3 years of customer service experience and 1 year of claims or appeals processing experience OR Bachelor’s Degree in lieu of work experience.
Excellent verbal and written communication skills.
Strong customer service skills.
Proficient spelling, punctuation, grammar, and basic business math.
Ability to handle confidential or sensitive information with discretion.
Knowledge of claims processing procedures.
Microsoft Office.

Responsibilities

Distribute daily work to employees, tracks workload and employee performance, and make appropriate decisions necessary to ensure all processing expectations and team goals are met.
Respond accurately and timely to inquiries from team members, including management, concerning customer inquiries, claims adjudication, appeals and other technical issues.
Investigates and initiates resolutions to complex problems.
Authorizes payment recovery, claim payments, or makes claim rejections based on documented information and provisions of state or federal law.
Identify issues with procedures and processes and provide feedback to management on changes and development.
Train new employees and introduce new material to all employees.
Develops, updates, and maintains procedural manuals.
Serve as liaison with other departments to address claim, system and quality issues.
May perform some testing functions and attend/participate in meetings as needed.