Summary
 

We are currently hiring for Claims Customer Service Advocate II to join BlueCross BlueShield of South Carolina. In this role you will be responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. You will also perform research as needed to resolve inquires, review and adjudicate claims and or non-medical appeals. While also determining 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 have 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 committed 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 8:00am-4:30pm.  The location for this position will be onsite at the Percival Rd. location in Columbia, SC with the possibility to work hybrid after the first 90 days.

What You Will Do:

• Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries. Handles 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 Will Need:

• High School Diploma or equivalent
• 2 years of customer service experience including 1 year claims OR appeals processing OR Bachelor's Degree in lieu of work experience.
• 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.
• Microsoft Office experience.
• Typical office environment.

What We Prefer:

• Claims Processing experience
• Insurance industry experience

What We Can Do for You:

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave – the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and healthy lifestyle premium discount.