Coordinator, Appeals

Appeals Coordinator

Position

Purpose:

The Appeals Coordinator role focuses on reviewing and screening appeals to ensure they are assigned to the correct document type, including researching requests, entering the appropriate data to identify case specifics, and building appeal cases in the system.

Logistics:
Palmetto GBA - one of Blue Cross Blue Shield's South Carolina subsidiary companies.

Location:

This is a full-time position (40-hours/week, Monday – Friday, 8:00 am – 5:00 pm). Work Setting:
Onsite at 200 Dozier Blvd, Florence, SC 29501 OR 17 Technology Circle, Columbia, SC 29203

This position requires CMS Security Clearance as it falls within a division subject to Centers for Medicare and Medicaid Services residency requirements.

SCA Benefit Requirements:
Blue Cross Blue Shield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage.

Your coverage begins on the first day of the month following 28 days of full-time employment.

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

What You Will Do:

• Researches requests, enters appropriate data to identify case specifics and builds appeals cases on the system.

• Logs requests to appropriate functional area, generates letters, assembles files, orders records and obtains additional information as directed.

• Ensures quality control of all appeals on the appeals system, pends documents to be saved electronically, and prepares case files for review and/or further routing.

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

• Required
  
  Education:
  
  High School Diploma or equivalent.

• Required
  
  Work Experience:
  
  1 year administrative support/clerical or job related experience.

• Required
  
  Skills and Abilities:
  
  Demonstrated proficiency in word processing and spreadsheet software. Effective organizational and customer service skills. Good judgment skills. Proficiency in spelling, punctuation, and grammar skills. Demonstrated written and verbal communication skills.

• Required Software and Other Tools:
  Microsoft Office.

We Prefer That You Have the Following:

• Preferred
  
  Work Experience:
  
  3 years-claims, customer service or healthcare program management.

• Preferred
  
  Skills and Abilities:
  
  Ability to persuade, negotiate, or influence.

• Preferred Software and Tools:
  Knowledge of Microsoft Access or other database software.

• Work Environment:
  Typical office environment.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace. We strive to be an employer across all spectrums where employees can develop their skills, advance their careers, and contribute their unique abilities to the growth of our company.

Our comprehensive benefits package includes :

• 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

• Wellness program and healthy lifestyle premium discount

• Tuition assistance

• Service recognition

• Employee Assistance

• Discounts to movies, theaters, zoos, theme parks and more

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

Blue Cross Blue Shield 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…