Job description
Summary
Functions as the team lead and subject-matter expert for a claims area. Responsible for creating reports, distributing workload and training new employees.
Description
Position Purpose:
As a member of Medicare Advantage team, you will function as the team lead and subject-matter expert for a claims area, and be responsible for creating reports, distributing workload, and training new employees.
Logistics:
This position is full-time (40 hours/week) Monday – Friday and is a work at home position with our normal business hours of 8:00 AM EST – 5:00 PM EST. It may be necessary, given the business need, to work occasional overtime and weekends. The physical address for this role is located at 17 Technology Circle in Columbia, SC.
What You’ll Do:
- Respond accurately and timely to inquiries from team members, including management, concerning claims processing and other technical issues.
- Investigate and initiate resolutions to complex claims problems.
- Train and assist new employees and unit personnel to ensure consistent application of established guidelines.
- Identify issues with procedures and processes and provide feedback to management on changes and development.
- Serve as liaison with other departments to address claim system and quality issues.
- May perform some testing functions and attend/participate in meetings as needed.
To Qualify for This Position, You’ll Need:
- A High School Diploma or equivalent.
- Four years of experience processing, researching, and adjudicating claims.
- Strong organizational, analytical, and problem-solving skills.
- Strong verbal and written communication skills.
- Strong interpersonal and time-management skills.
- Strong spelling, punctuation, and grammar skills.
- Basic business math proficiency.
- The ability to handle confidential or sensitive information with discretion.
- Knowledge of Microsoft Office applications.
We
Prefer That You Have:
- An Associate Degree.
- Knowledge of mathematical or statistical concepts.
- The ability to persuade, negotiate, or influence.
What Blue Can Do for You:
You are not alone. We are here to support you.
Six weeks of classroom and training lab, including:
- A classroom environment, live trainer and open discussion.
- A proven curriculum providing the knowledge you need to excel.
Our comprehensive benefits package includes:
- 401(k) retirement savings plan with company match.
- Subsidized health plans and free vision coverage.
- Life insurance.
- Paid annual leave — the longer you work here, the more you earn.
- Nine paid holidays.
- On-site cafeterias and fitness centers in major locations.
- Wellness programs and a healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
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.
Management will be conducting interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
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 minorities, females, disabled individuals and 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 physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
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