Appeals Specialist

Summary: 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, operate one of the most sophisticated data processing centers in the Southeast, and have a diverse family of subsidiary companies.

About the role

An Appeals Specialist performs non-medical reviews and processes redetermination letters.

Location: This position is based on site at the 4101 Percival Road, Columbia, SC 29229 location.

Work hours: 8:30 AM – 5:00 PM.

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

Responsibilities

• Performs non-medical reviews and processes redetermination letters ensuring timeliness and accuracy.
• Prepares unit reports, analyzes and interprets workload, and processes issues utilizing various software tools.
• Updates letters and documents within the department when necessary.
• May gather and prepare documentation for legal inquiries and administrative requests.

Requirements

• High School Diploma or equivalent
• 2 years of job-related field experience
• Demonstrated proficiency in word processing and spreadsheet software
• Excellent organizational, customer service, and written and verbal communication skills
• Good judgment skills
• Proficiency in spelling, punctuation, and grammar skills
• Proficiency with Microsoft Office

Work Environment: Typical office environment.

Preferred Qualifications

• Experience using Cohere and Genesys applications, with the ability to navigate and utilize these systems effectively
• Operational experience with pre-service and post-service authorizations
• Ability to effectively utilize multiple systems and tools to support operational and member/provider service needs

Benefits

• 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

Benefits eligibility begins the first of the month following 28 days of employment.