Claims & Appeals Support Specialist II

001 BlueCross and BlueShield of South Carolina

Myrtle Beach (SC)

On-site

USD 36,000 - 54,000

Full time

3 days ago

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Job summary

PGBA, LLC, a leading administrator of TRICARE and health benefit programs, seeks a Claims Processing/Customer Service professional in the Myrtle Beach area to respond to routine inquiries by phone, identify misprocessed claims, and complete adjustments and reprocessing actions.

The role emphasizes accuracy, discretion with confidential information, and strong written and verbal communication, with opportunities to contribute to process improvements within a supportive, federal contractor

Qualifications

Clear verbal and written communication skills.
Strong customer service skills.
Excellent spelling, punctuation and grammar.
Basic business math proficiency.
Ability to handle confidential or sensitive information with discretion.

Responsibilities

Researches and responds to telephone inquiries according to desk procedures, ensuring timeliness, productivity and quality.
Researches and responds to written inquiries and identifies misprocessed claims, completing adjustments and/or reprocessing actions; initiates recoupments as needed.
Identifies complex complaints and inquiries and refers them to a lead or manager for resolution; reports potential fraud and abuse.
Completes projects and assignments related to claims processing and customer service.