Summary
 

We are currently hiring for a FCMB 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. Perform research as needed to resolve inquiries. Review and adjudicates complex or specialty claims and/or non-medical appeals. Determine 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 work a shift from 10:00am to 7:00pm.  Training will be from 8:00am to 5:00pm. It may be necessary, given the business need to work occasional overtime. This position is located at 17 Technology Circle, Columbia, SC.

Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. 

 

SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date. 

What You'll Do:

• Reviews 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.
• Identify and report potential fraud and abuse situations.
• Research and respond to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity and quality are met.
• Handle situations that require adaptation of response or extensive research.
• Examine and processes 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.
• Provide feedback to management regarding customer issues. Maintain accurate records concerning issues.
• Follow through on complaints until resolved or report to management as needed.