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
 

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.

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.

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