Summary
 

We are currently hiring for a Claims Customer Service Advocate II to join BlueCross BlueShield of South Carolina. In this role as a Claims Customer Service Advocate II and as a Government Customer Service team member, you will be responsible for responding to routine correspondence and telephone inquiries on claims or appeals and identify incorrectly processed claims and complete 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 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 full time (40 hours/week) Monday-Friday from 8:00am – 5:30pm EST and will be on-site in Myrtle Beach, SC. Mandatory 3-month training program will be on-site with the possibility of remote work after training based upon performance.

What You Will Do:

· Research and respond 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, identify incorrectly processed claims, and complete 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.

· Identify 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.

· Identify and reports potential fraud and abuse situations.

· Complete projects and/or assignments related to the department's claims processing and customer service functions.

· The work environment is the typical office environment.

· You will be required to obtain a government (C-2) clearance.

To Qualify for This Position, You Will Need:

· High School Diploma OR equivalent.

· Good verbal and written communication skills.

· Strong customer service skills

· Good spelling, punctuation, and grammar skills

· Ability to handle confidential or sensitive information with discretion.

What We Prefer:

· Two years of customer service experience OR One year of claims or appeals processing experience and one year of customer service experience OR a bachelor's degree in place of work experience.

What We Can Do for You:

· 401(k) retirement savings plan with company match.

· Subsidized health plans and free vision coverage.

· Life insurance.

· Paid annual leave – the longer you work here, the more you earn.

· Nine paid holidays.

· On-site cafeterias and fitness centers in major locations.

· Wellness programs and healthy lifestyle premium discount.

· Tuition assistance.

· Service recognition.

· Incentive Plan.

· Merit Plan.

· Continuing education funds for additional certifications and certification renewal.

What to Expec