Summary
 

We are currently hiring for a Claims Customer Service Advocate II to join BlueCross BlueShield of South Carolina. You will be responsible for or responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifying incorrectly processed claims and completes adjustments and related reprocessing actions.

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
 

Position Purpose:

This role directly helps our customers in a timely, prompt, and accurate way to answer some of their most worrisome health care questions and claims concerns. This job can be complex and may require research as well as the ability to feel comfortable going off-script to ensure our customer's questions are answered correctly the first time.

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. 

Logistics:

This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to work an 8 hour shift during the hours of 10:00am to 7:00pm. It may be necessary, given the business need to work occasional overtime. This position is located at 200 Nort Dozier Boulevard, Florence, SC 29501.

What You'll Do:

• Researches and responds to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
• Research and respond to written inquiries and identify incorrectly processed claims and completes the adjustment and/or reprocessing action according to department guidelines.
• This may include initiating, documenting, and processing the request to completion. Initiate recoupments as necessary.
• Identifies complaints and inquiries of a complexity level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution.
• Identifies and reports potential fraud and abuse situations.
• Completes projects and/or assignments related to claims processing and customer service functions in the department.