Claims & Appeals Specialist

BlueCross and BlueShield of South Carolina; Florence (SC); On-site; USD 32,000 - 42,000; Full time

Benefits offered by this job

Health benefits

401k retirement plan with companymatch

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Job summary

BlueCross BlueShield of South Carolina in Florence, SC is seeking a full-time Member Services Representative. You will respond to routine inquiries about claims and appeals, guide members and providers, and use computer-based resources to resolve questions.

The role requires strong communication, accuracy, and discretion. Training is provided, with opportunities to contribute to process improvements and respond to complex situations as needed.

Qualifications

• High School Diploma or equivalent required.
• 2 years customer service experience OR 1 year claims/appeals processing plus 1 year customer service.
• Strong verbal and written communication and professional discretion.
• Proficiency in basic business math.
• Proficiency with Microsoft Office.

Responsibilities

• Research and respond to telephone inquiries, meeting desk procedures and quality targets.
• Identify incorrectly processed claims and complete adjustments and reprocessing actions.
• Escalate complex inquiries to a lead or manager and report potential fraud or abuse.
• Complete projects related to claims processing and customer service functions.

Skills

Verbal communication

Written communication

Customer service

Spelling/grammar

Basic math

Education

High School Diploma

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina in Florence, SC is seeking a full-time Member Services Representative. You will respond to routine inquiries about claims and appeals, guide members and providers, and use computer-based resources to resolve questions.

The role requires strong communication, accuracy, and discretion. Training is provided, with opportunities to contribute to process improvements and respond to complex situations as needed.