Claims Resolution Specialist I

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 42,000 - 54,000; Full time

Benefits offered by this job

Subsidized health plans

401K retirement savings with company

Life Insurance

Paid Time Off

On-site cafeterias and fitness centers

Wellness program

Tuition assistance

Service recognition

Employee Assistance

Discounts to movies

Job summary

BlueCross BlueShield of South Carolina is seeking a claims specialist to respond to routine inquiries, identify incorrectly processed claims, and complete adjustments and reprocessing actions. You will review and adjudicate claims and non-medical appeals following organizational policies in a full-time, on-site role in Columbia, SC.

Work hours are 8:00 AM–5:00 PM, Monday–Friday, with training during first weeks. You must be a U.S.

Qualifications

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

Responsibilities

• Responds to inquiries by phone or written methods following desk procedures.
• Documents inquiries accurately and processes adjustments.
• Reviews and adjudicates claims and/or non-medical appeals per regulations.
• Enters claims into the system after verification of codes.
• Ensures processing meets established quality and production standards.
• Escalates complex issues to a lead or manager.
• Identifies and reports suspected fraudulent activities and system errors.

Skills

Verbal communication

Written communication

Customer service

Spelling & grammar

Math basics

Confidentiality

Education

High School Diploma or equivalent

Bachelor's Degree preferred

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a claims specialist to respond to routine inquiries, identify incorrectly processed claims, and complete adjustments and reprocessing actions. You will review and adjudicate claims and non-medical appeals following organizational policies in a full-time, on-site role in Columbia, SC.

Work hours are 8:00 AM–5:00 PM, Monday–Friday, with training during first weeks. You must be a U.S.