Summary
 

lueCross BlueShield of South Carolina. In this role as a Customer Service Advocate I, you will be responsible for responding to routine inquiries. Identify incorrectly processed claims and completes adjustments and related reprocessing actions. Review and adjudicate 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 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 on-site full-time Monday-Friday in a typical office environment. Employees are required to work from 8:00 AM to 5:00 PM. Training will be from 8:00 AM to 5:00 PM for approximately 4-8 weeks. It may be necessary, given the business need to work occasional overtime and weekends. This role is located at the Government Programs Complex building located at 17 Technology Circle, Columbia, SC 29203.

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.

To Qualify for This Position, You'll Need:

• 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 prefer you have:

• 2 years of customer service experience OR 1 year of claims or appeals processing experience and 1 year of customer service experience OR Bachelor's Degree in lieu of work experience.

Work Environment:

• Typical office environment.

What We Can Do for You:

We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have access and opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Our comprehensive benefits package includes:

• 40