Coordinator, Claims Customer Service

BlueCross BlueShield of South Carolina•Columbia, SC

2d•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 with hours from 830am-5pm. This position is located onsite at 4101 Percival Road, Columbia SC. 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, claims 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

Required Education: High School Diploma or equivalent
Required Work Experience: 3 years of customer service experience and 1 year of claims or appeals processing experience OR Bachelor’s Degree in lieu of work experience
Required Skills and Abilities: 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
Required Software and Other Tools: Microsoft Office

Responsibilities

Distribute daily work to employees
Tracks workload and employee performance
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, claims 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