Claims & Appeals Specialist II – Customer Care Advocate

Blue Cross Blue Shield Association; Myrtle Beach (SC); On-site; USD 38,000 - 56,000; Full time

Benefits offered by this job

Subsidized health plans, dental and視on

401K retirement savings plan with公司匹配

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers

Wellness program and healthy lifestyle

Tuition assistance

Service recognition

Employee Assistance

Discounts to movies, theaters, zoos, &

Job summary

BlueCross BlueShield of South Carolina is seeking a dedicated professional to handle routine correspondence and phone inquiries related to claims or appeals. You will identify incorrectly processed claims and perform adjustments and reprocessing actions, maintaining accuracy and service quality.

Working on site in a full-time role, you will support processing and documentation, ensuring timely responses and compliance with contractual standards. Training will be provided.

Qualifications

• High school diploma or equivalent.
• 1 year of experience including 1 year claims/appeals processing, customer service, or other related support area OR bachelor’s degree in lieu of work experience.
• Good Verbal and Written Communication Skills

Responsibilities

• Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
• Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
• Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution.

Skills

Customer service

Communication skills

Attention to detail

Education

High School Diploma

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a dedicated professional to handle routine correspondence and phone inquiries related to claims or appeals. You will identify incorrectly processed claims and perform adjustments and reprocessing actions, maintaining accuracy and service quality.

Working on site in a full-time role, you will support processing and documentation, ensuring timely responses and compliance with contractual standards. Training will be provided.