Coordinator, Appeals

Overview

Blue Cross Blue Shield of South Carolina and its subsidiary companies have been serving the South Carolina community for more than seven decades, operating the state’s largest insurance company and leading administrators of government contracts.

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.

Work setting:
Onsite at 200 Dozier Blvd, Florence, SC 29501 or 17 Technology Circle, Columbia, SC 29203. Full‑time (40 hours/week, Monday – Friday, 8:00am – 5:00pm).

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

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

• Research requests, enter appropriate data to identify case specifics, and build appeals cases in the system.
• Log requests to appropriate functional area, generate letters, assemble files, order records and obtain additional information as directed.
• Ensure quality control of all appeals on the appeals system, pend documents to be saved electronically, and prepare case files for review and/or further routing.

• 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; proficiency in spelling, punctuation, and grammar; demonstrated written and verbal communication skills.
• Required Software and Other Tools: Microsoft Office.

• 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.

Typical office environment.

• 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

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 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.

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. We participate in E‑Verify and comply with the Pay Transparency Nondiscrimination Provision.