Coordinator, Claims Customer Service

BlueCross BlueShield of South Carolina•Columbia, SC

1d•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. Employees are required to have flexibility to work any of our 8-hour scheduled shifts during the hours of 8:00 AM –4:30 PM OR 9:30am to 6:00 pm. Training will be Monday – Friday 8:00 AM - 4:30 PM for approximately 6-8 weeks on site at 4101 Percival Road, Columbia SC. This is a located-on site at 4101 Percival Road, Columbia SC.

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

Distributes daily work to employees, tracks workload and employee performance, and makes appropriate decisions necessary to ensure all processing expectations and team goals are met.
Responds 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, claims payments, or makes claim rejections based on documented information and provisions of state or federal law.
Identifies issues with procedures and processes and provides feedback to management on changes and development.
Trains new employees and introduces new material to all employees.
Develops, updates, and maintains procedural manuals.
Serves as liaison with other departments to address claim, system and quality issues.
May perform some testing functions and attend/participate in meetings as needed.