Claims Customer Service Representative

3 weeks ago


Myrtle Beach, South Carolina, United States BlueCross BlueShield of South Carolina Full time

About the Role

This Claims Customer Service Associate I position is a full-time opportunity in a typical office environment, Monday through Friday. The role involves responding to written and/or telephone inquiries, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. The ideal candidate will have excellent communication skills, strong customer service skills, and the ability to handle confidential or sensitive information with discretion.

Key Responsibilities

  • Respond to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
  • Accurately document inquiries and identify incorrectly processed claims, processing adjustments and reprocessing actions according to department guidelines.
  • Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines.
  • Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution.

Requirements

  • High School Diploma or equivalent.
  • One year of experience in claims/appeals processing, customer service, or other related support areas OR Bachelor's Degree in lieu of work experience.
  • 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.
  • Microsoft Office.

Preferred Qualifications

  • TRICARE customer service or claims experience.

What We Offer

  • Comprehensive benefits package, including 401(k) retirement savings plan with company match, subsidized health plans, and free vision coverage.
  • Life insurance, paid annual leave, and nine paid holidays.
  • On-site cafeterias and fitness centers in major locations, wellness programs, and healthy lifestyle premium discount.
  • Tuition assistance and 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 a recruiter to verify resume specifics and salary requirements. Management will interview the most qualified candidates, prioritizing those who demonstrate the preferred qualifications.

Work Environment: Typical Office Environment.

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



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