Summary
 

We are currently hiring for a Claims Customer Service Advocate III to join BlueCross BlueShield of South Carolina. You will be responsible for providing prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates complex or specialty claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures.

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.

Description
 

Logistics:

This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have the flexibility to work any of our 8-hour shift scheduled during our normal business hours. It may be necessary, given the business need to work occasional overtime and weekends. This role is located at 17 Technology Circle, Columbia, SC 29203

What You'll Do:

• Review claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed.
• Research to identifying underlying causes and determine ways to prevent and correct such causes.
• Identifies and reports potential fraud and abuse situations.
• Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity and quality are met.
• Handles situations that require adaptation of response or extensive research.
• Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
• Ensures claims are processing according to established quality and production standards.
• Provide feedback to management regarding customer issues.
• Maintain accurate records concerning issues.
• Follow through on complaints until resolved or report to management as needed.
• Maintain knowledge of procedures and policies.
• Assist with process improvements by recommending improvements in procedures and policies.
• Assists in training claims customer service representatives.

To Qualify for This Position, You'll Need:

• 3 years of customer service experience, including 1 year of claims or appeals processing experience 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 abilities.
• Ability to handle confidential or sensitive inform