Summary
 

Position Purpose:
In the role as the Claims Customer Service Advocate II, one will be responsible for responding to customer inquiries. These inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. The ideal candidate will also perform research as needed to resolve inquiries. One will review and adjudicate claims and/or non-medical appeals as well as determines whether to return, deny or pay claims following organizational policies and procedures.

Description
 

Claims Customer Service Advocate II

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!

Logistics:

This position is full-time position (40 hours per week) Monday through Friday 7:45am-4:15 pm reporting onsite to 4101 Percival Road Columbia, SC 29219.   

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:

• 2 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

• Microsoft Office

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 r