BlueCross BlueShield of South Carolina

Appeals Director

Healthcare
5 - 7 years of experience
Job Overview by Ladders

Qualifications

  • Bachelor's degree is required.
  • 7 years of healthcare program or customer service experience, including budget management.
  • 3 years of management/supervisory experience or 3 years of military experience at grade E4 or above.
  • Strong organizational, analytical, presentation, and customer service skills.
  • Proficient in Microsoft Office software.

Responsibilities

  • Direct customer service, claims processing, and appeals staff to ensure prompt and accurate inquiries.
  • Track performance and develop measures of success; implement process improvements.
  • Identify system limitations and lead enhancements and updates.
  • Support achievement of departmental and corporate objectives; resolve multi-functional issues.
  • Develop and monitor budget and resources; manage staff selection, training, and development.

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.
Full Job Description

Summary

Provides direction and guidance to appeals, customer service, and claims processing staff for multiple operational areas.

We strongly prefer experience in FISS, MAS, PECOS, and HIGLAS and management in a Medicare Administrative Contractor operational setting.
Description

Location: This position is onsite full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours of 8:00AM-5:00PM. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 17 Technology Circle Columbia, SC 29203

What You Will Do:

  • Directs customer service, claims processing, and/or appeals staff in ensuring prompt and accurate processing of items and inquiries. Develops and supports strategic initiatives to enhance provider and customer satisfaction.

  • 20% Works closely with areas to track performance and develop measures of success. Implements process improvements.

  • 10% Identifies system limitations and serves as project leader on system enhancements and updates.

  • 10% Leads and supports achievement of departmental, divisional, and corporate strategic objectives. Collaborates with other functional areas to resolve multi-functional issues. Provides necessary assistance and resources when necessary.

  • 10% Develops and monitors budget and resources for all assigned areas. Responsible for the selection, training, and development of staff. Ensures excellent customer service is given to employees, customers, management, etc.

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

  • Required Education: Bachelor's

  • Degree Equivalency: 4 years job related work experience or Associate's and 2 years job related work experience (Equivalency not applicable for the Celerian Group. Bachelor's degree required.)

  • Required Work Experience: 7 years of healthcare program or customer service experience to include budget management experience including 3 years of management/supervisory experience OR 3 years of equivalent military experience in grade E4 or above (may be concurrent).

  • Required Skills and Abilities: Strong organizational, analytical, presentation, and customer service skills. Strong oral and written communication skills. Ability to persuade, negotiate or influence. Ability to handle confidential or sensitive information with discretion. Proficient spelling, punctuation, grammar, and basic business math.

  • Required Software and Tools: Microsoft Office.

We Prefer You to Have:

  • Experience in FISS, MAS, PECOS, and HIGLAS

  • Management in a Medicare Administrative Contractor operational setting

Our Comprehensive Benefits Package Includes the Following:

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

What We Can Do for You:

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.

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.

About BlueCross BlueShield of South Carolina

BlueCross BlueShield of South Carolina is a health insurance company that provides coverage to over 5 million people in South Carolina and beyond. The company was founded in 1946 and is headquartered in Columbia, South Carolina. BlueCross BlueShield of South Carolina offers a variety of health insurance plans, including individual and family plans, Medicare plans, and employer-sponsored plans. The company is committed to improving the health of its members and the communities it serves, with initiatives focused on wellness, disease prevention, and access to care. BlueCross BlueShield of South Carolina is a subsidiary of the Blue Cross Blue Shield Association, a national federation of 36 independent, community-based and locally operated Blue Cross Blue Shield companies.
Learn more about BlueCross BlueShield of South Carolina
Size
12,000 employees
Industry

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