Senior Claims & Appeals Specialist

001 BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 42,000 - 64,000; Full time

Benefits offered by this job

Subsidized health plans

Dental and vision coverage

401k with company match

Life Insurance

Paid Time Off

Job summary

BlueCross BlueShield of South Carolina is seeking a detail-oriented Claims/Appeals Specialist to review complex inquiries and adjudicate claims according to policies. The role requires research, adherence to timelines, and collaboration with customer service to resolve issues.

The position is full-time in a typical office setting with standard business hours and training. Excellent communication and discretion are essential to succeed in this role.

Qualifications

• 3 years of customer service experience, including 1 year of claims or appeals processing experience OR Bachelor's Degree in lieu of work experience.
• Good verbal and written communication skills; strong customer service skills.
• Ability to handle confidential or sensitive information with discretion.

Responsibilities

• Review claims or appeals issues to determine if desk procedures and guidelines were followed.
• Research to identify underlying causes and determine preventive actions.
• Identify and report potential fraud and abuse situations.
• Research and respond to complex customer inquiries ensuring timeliness and quality.
• Examine and process claims and non-medical appeals according to regulations and guidelines.
• Enter claims into the system after verification of coding procedures and diagnoses.

Skills

Strong customer service

Good written communication

Attention to detail

Basic math skills

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina is seeking a detail-oriented Claims/Appeals Specialist to review complex inquiries and adjudicate claims according to policies. The role requires research, adherence to timelines, and collaboration with customer service to resolve issues.

The position is full-time in a typical office setting with standard business hours and training. Excellent communication and discretion are essential to succeed in this role.