Summary
 

Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries.

Description
 

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but we've been part of the national landscape for more than seven decades, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies, allowing us to build on various business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Position Purpose:

Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.

Logistics:

National Alliance - – one of BlueCross BlueShield's South Carolina subsidiary companies.

 

Location:

This position is part-time (33 hours/week) Monday through Friday in a typical office environment or home environment. You will work a 6.5-hour shift scheduled during our normal business hours of 2pm to 8pm. This scheduled is not flexible. Overtime may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located on-site at 4101 Percival Road, Columbia, SC. Training will be onsite Monday-Friday 8:00 AM -4:30PM for approximately 8-10 weeks. W@H will be considered after 90-day performance review, equipment issuance and LOB business needs review.

Sponsorship: This position is not eligible for sponsorship now or in the future.

What You’ll Do:

• Responsible for accurate and timely responses to complex telephone, written, web, or walk-in inquiries. Handles situations which may require adaptation of response or extensive research. Maintain all departmental productivity, quality and timeliness standards.
• Initiate corrective actions, process adjustments, or perform other research to resolve inquiries. Evaluate inquiries to identify underlying causes and implement actions to prevent future issues. Coordinate with other departments to resolve problems.
• Provide feedback to management regarding customer issues. Maintain accurate records concerning issues. Follow through on inquiries until resolved or report to management as needed.
• Maintain knowledge of procedures and policies. Assist with process improvements by recommending improvements in procedures and policies.
• Assist with the training of new employees and cross training of coworkers

 

To Qualify for This Position, You'll Need the Following:

• Required Education: 
• High School Diploma or equivalent
• Required Work Experience:
• 2 Years of Customer service or claims processing experience OR Bachelor's Degree in lieu of work experience.
• Required Skills and Abilities: 
• Strong oral and written communication skills.
• Proficient in spelling, punctuation, and grammar.
• Strong organizational, analytical, and customer service skills.
• Ability to handle high stress situations. Basic business math proficiency.
• Ability to handle confidential or sensitive information with discretion.
• Ability to learn and operate multiple computer systems effectively and efficiently.
• Required Software and Other Tools: 
• Microsoft Office.

We Prefer You Have the Following:

• Preferred Work Experience:
• 3 Years-Customer service or claims processing experience.
  Preferred Education:
• Associate degree-Any Major
  Preferred Skills and Abilities:
• Ability to persuade, negotiate or influence.
  Preferred Software and Other Tools:
• Knowledge of database software
• Preferred Location:
• We prefer you live within 50 miles of the work site to attend mandatory meetings and departmental trainings.

What We Can Do for You:

We strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains affirmative action programs to promote employment opportunities for individuals with disabilities and protected veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Here's more information.

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