Florence, South Carolina, United States · On-site
Summary We are currently hiring for a Customer Service Phone Advocate I to join BlueCross BlueShield of South Carolina. You will be responsible for providing prompt, accurate, thorough and courteous responses to all tele…
Skills: Verbal Communication, Human Relations, Organizational Skills, Stress Management, Judgment Skills
Lexington County, South Carolina, United States · Remote OK
Summary Acts as Team Lead for specialty programs, medical review, utilization management, and case management areas by providing assistance and support to unit supervisor/manager by giving direction/guidance/training to …
Skills: Medical Review, Utilization Management, Case Management, Leadership, Staff Training
Lexington County, South Carolina, United States · Remote OK
Summary Performs medical reviews using clinical/medical information provided by physicians/providers and established criteria/protocol sets or clinical guidelines. Documents decisions using indicated protocol sets or cli…
Skills: Medical Review, Utilization Management, Clinical Guidelines, Medical Coding, Medical Necessity Determination
South Carolina, United States · Remote Solely
$53k–$102k/yr
Summary We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coord…
Skills: Care Management, Case Management, Clinical Assessment, Motivational Interviewing, Utilization Review
Columbia, South Carolina, United States · On-site
Summary 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 roo…
Skills: Inventory Balancing, Reconciliations, Journal Entries, Accounts Payable, Accounts Receivable
Myrtle Beach, South Carolina, United States · On-site
Summary Responsible for the accurate and timely processing of claims. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) M…
Skills: Claims Processing, Analytical Skills, Organizational Skills, Customer Service, Oral Communication
Nashville, Tennessee, United States · Hybrid
Summary Provides all redetermination case file information within the specified time requirement while maintaining accuracy and departmental standards. Suspends claims in applicable claim system and tracks all data. Desc…
Skills: Organizational Skills, Decision Making, Customer Service, Detail Oriented, Analytical Thinking
Myrtle Beach, South Carolina, United States · On-site
Summary Responsible for the accurate and timely processing of claims. Description Logistics: PGBA – one of BlueCross BlueShield's South Carolina subsidiary companies Location: This position is full-time (40-hours/week) M…
Skills: Claims Processing, Analytical Skills, Organizational Skills, Customer Service, Oral Communication
South Carolina, United States · Hybrid
Summary We are currently hiring for a Case Management Coordinator to join BlueCross BlueShield of South Carolina. In this role as a Case Management Coordinator, care management interventions focus on improving care coord…
Skills: Care Management, Case Coordination, Medical Necessity Review, Motivational Interviewing, Patient Education
Columbia, South Carolina, United States · On-site
Summary Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals. Dete…
Skills: Claims Processing, Appeals Processing, Customer Service, Verbal Communication, Written Communication
Columbia, South Carolina, United States · On-site
Summary Responsible in the provider enrollment process to review, research, analyze, and process provider enrollment applications. Ensures provider file integrity and that suppliers are in compliance with established sta…
Skills: Provider Enrollment, Data Verification, Customer Service, Analytical Thinking, Microsoft Office
Columbia, South Carolina, United States · On-site
Summary 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 roo…
Skills: Inventory Balancing, Reconciliations, Journal Entries, Accounts Payable, Accounts Receivable
Columbia, South Carolina, United States · On-site
Summary Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals. Dete…
Skills: Claims Processing, Customer Service, Appeals Processing, Verbal Communication, Written Communication
Columbia, South Carolina, United States · Remote OK
Summary This position is remote however it is required to live in or around Columbia, South Carolina. Conducts primary/secondary market research to be used in development of new products/programs. Provides information in…
Skills: Market Research, Project Coordination, Strategic Planning, Microsoft Office Suite, Business Development
Nashville, Tennessee, United States · Remote Solely
Summary Researches the substance of complex appeal or retrospective review requests including pre-pay and post-payment review appeal requests. Provides thorough clinical review or benefit analysis to determine if the req…
Skills: Clinical Review, Benefit Analysis, Medical Necessity Guidelines, Utilization Review, Quality Assurance
Columbia, South Carolina, United States · Remote OK
Summary Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly em…
Skills: Product Management, Vendor Management, Market Strategy, Sales Support, Data Analysis
Columbia, South Carolina, United States · On-site
Summary Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. De…
Skills: Verbal Communication, Written Communication, Customer Service, Spelling, Punctuation
Columbia, South Carolina, United States · On-site
Summary Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. De…
Skills: Claims Processing, Appeals Processing, Customer Service, Verbal Communication, Written Communication
Columbia, South Carolina, United States · Hybrid
Summary Maintains all quality management system documentation at the company level. Assists and trains functional document control administrators and management in documenting procedures in accordance with certification …
Skills: Quality Management Systems, Document Control, ISO 9000, Medical Records Management, HIPAA Compliance
Beaufort County, South Carolina, United States · Remote OK
$49k–$95k/yr
Summary Responsible for providing a full range of financial, compliance, and operational audits, business advisory and consultation services, investigations, internal controls, accountability, and use of resources. Descr…
Skills: Financial Auditing, Compliance Auditing, Operational Auditing, Internal Controls Evaluation, Risk Assessment
Florence, South Carolina, United States • On-site
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Provide prompt and accurate responses to telephone inquiries while documenting interactions and performing research to resolve customer issues. Coordinate with other departments to resolve problems and provide feedback to management regarding customer needs.
Requires a high school diploma or equivalent with strong communication and computer skills. An associate degree and two years of customer service or call center experience are preferred.
This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to work a shift from 8:00am to 5:00pm. Training will be from 8:00am to 5:00pm. It may be necessary, given the business need to work occasional overtime. This position is located onsite at 200 North Dozier Boulevard, Florence, SC 29501.
Ensures effective customer relations by responding accurately, timely and courteously to telephone inquiries. Accurately documents inquiries.
Initiates minor /clerical adjustments based on provider request or processes adjustments or performs other research as needed to resolve inquiries. Coordinates with other departments to resolve problems. Responds to, researches and/or assists with priority inquiries and special projects as required by management.
Provides feedback to management regarding customer problems, questions and needs. Maintains accurate records on complaints and/or other customer comments, and makes recommendations for changes to management. Follows through on complaints until resolved or reports to management as needed.
Maintains basic knowledge of quality work instructions and company policies. Assists with process improvements through the recommendation of changes in procedures and techniques discovered during daily operations. Maintains all departmental productivity, quality, and timeliness standards.
Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.
Required Education: High School Diploma or equivalent
Required Skills and Abilities: Excellent verbal communication skills. Strong human relations and organizational skills. Ability to handle high stress situations. Good judgment skills. Strong customer service skills. Ability to learn and operate multiple computer systems effectively and efficiently.
Required Software and Other Tools: Basic computer operating skills. Standard Office Equipment.
Preferred Education: Associate Degree.
Preferred Work Experience: 2 years-customer service or call center experience.
Preferred Software and Other Tools: Knowledge of word processing, spreadsheet, and database software.
Typical Office Setting.
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
Subsidized health plans, dental and vision coverage
401k retirement savings plan with company match
Life Insurance · Paid Time Off (PTO)
On-site cafeterias and fitness centers in major locations
Education Assistance
Service Recognition · National discounts to movies, theaters, zoos, theme parks and more
We understand the value of a diverse and inclusive workplace and 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. '
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 [email protected] 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.
Some states have required notifications. Here's more information.
South Carolina’s largest and oldest health insurance company
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now! BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. We are an Equal Opportunity Employer. We will consider all qualified applicants for employment 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.
Offices: I-20 E at Alpine Road, Columbia, South Carolina 29219, US
South Carolina’s largest and oldest health insurance company
For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state. We are the largest insurance company in South Carolina. We are also the only one that has an A+ Superior A.M. Best rating. We are one of the nation's leading government contract administrators. We operate one of the most sophisticated data processing centers in the Southeast and have a diverse family of subsidiary companies. Our full-time employees enjoy benefits like a 401(k) retirement savings plan with company match, subsidized health plans, free vision coverage, life insurance, paid annual leave and holidays, wellness programs and education assistance. If you are a full-time employee in the National Guard or reserves, we will cover the difference in your pay if you are called to active duty. BlueCross has a dedicated corporate culture of community support. Our employees are some of the most giving in the country. They support dozens of nonprofit organizations every year. If you're ready to join a diverse company with secure, community roots and an innovative future, apply for a position now! BlueCross BlueShield of South Carolina is an independent licensee of the Blue Cross and Blue Shield Association. We are an Equal Opportunity Employer. We will consider all qualified applicants for employment 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.
Offices: I-20 E at Alpine Road, Columbia, South Carolina 29219, US
