Summary
 

We are hiring a Claims Customer Service Advocate II. 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. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. The successful candidate for this position will be someone who pays strong attention to detail and is comfortable working in a high volume, fast-paced environment.

Description
 

This position is full-time (40 hours/week, 8 hours/day), on-site, Mon-Fri at our location in Columbia, SC. (4101 Percival Road 29229, Columbia, SC).

What You'll Do:

• Ensures 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.

• Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.

• Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.

• Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.

• Ensures claims are processing according to established quality and production standards.

• Identifies 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.

• Identifies and reports potential fraud and abuse situations.

To Qualify for This Position, You'll 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.

• Proficiency with Microsoft Office Products.

We Prefer You to Have:

• Associate degree

• Prefer (2) years claims experience and/or Healthcare Management

• 1-2 years in a healthcare environment, ie. doctor office, hospital, urgent care, etc.

• 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.

What Blue 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 the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

Our comprehensive benefits package includes:

• Subsidized health plans, dental and vision coverage

• 401K retirement savings plan with company match

• Life Insurance

• Paid Time Off