Senior Complex Claims & Appeals Advocate

BlueCross and BlueShield of South Carolina; Columbia (SC); On-site; USD 40,000 - 53,000; Full time

Benefits offered by this job

Health insurance

Benefits after 28 days

Job summary

BlueCross BlueShield of South Carolina in Columbia seeks a Customer Service Claims Specialist. You will provide prompt, accurate responses to complex inquiries, research issues, and adjudicate claims and appeals in line with policies.

This on-site, full-time role requires 3 years of customer service experience (1 year claims processing) or a Bachelor's degree, a high school diploma, and strong communication. Training is on-site; benefits begin after 28 days.

Qualifications

• 3 years of customer service experience, including 1 year in claims or appeals processing, OR a Bachelor's Degree in lieu of work experience.
• High School Diploma or equivalent required.
• Strong verbal and written communication; ability to handle confidential information with discretion.

Responsibilities

• Review claims or appeals and determine adherence to desk procedures; research causes and prevent recurrences.
• Research and respond to complex inquiries, ensuring timeliness, productivity and quality.
• Examine and process claims/ non-medical appeals per regulations and internal standards; enter into claims system.
• Provide feedback to management; maintain accurate records; follow up on complaints until resolved.
• Maintain knowledge of procedures; assist in training claims customer service representatives.

Skills

Verbal communication

Written communication

Customer service

Confidential information handling

Business math

Education

High School Diploma or equivalent

Tools

Microsoft Office

Job description

BlueCross BlueShield of South Carolina in Columbia seeks a Customer Service Claims Specialist. You will provide prompt, accurate responses to complex inquiries, research issues, and adjudicate claims and appeals in line with policies.

This on-site, full-time role requires 3 years of customer service experience (1 year claims processing) or a Bachelor's degree, a high school diploma, and strong communication. Training is on-site; benefits begin after 28 days.