Claims Customer Service Advocate II

Summary

Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.

Description

Logistics: This position is full-time position (40 hours per week) Monday through Friday. Employees are required to have the flexibility to work any 8-hour shift during the hours of 8:00am - 6:00 pm reporting onsite to 4101 Percival Road, Columbia, SC 29229.

What You’ll Do

• Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries
• Handle situations which may require adaptation of response or extensive research
• Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines
• Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines
• Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes
• Ensure claims are processing according to established quality and production standards
• Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution
• Identify and report potential fraud and abuse situations
  
  

To Qualify For This Position, You’ll Need

• Two years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience
• High School Diploma or equivalent
• Good verbal and written communication skills
• Strong customer service skills
• Good spelling, punctuation, and grammar skills
• Basic business math proficiency
• Ability to handle confidential or sensitive information with discretion
  
  

What We Can Do For You

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
• 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 your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications require proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, 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.

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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 minorities, females, disabled individuals and 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 physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail mycareer.help@bcbssc.com or call 1-800-288-2227, 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.