Summary
 

We are currently hiring for a Claims Customer Service Advocate I to join BlueCross BlueShield of South Carolina. In this role as Claims Customer Service Advocate I, you are responsible for responding to routine inquiries, identifying incorrectly processed claims, and completing adjustments and related reprocessing actions. Reviewing and adjudicating claims and/or non-medical appeals. Determining whether to return, deny or pay claims following organizational policies and procedures.

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, onsite (40 hours/week) Monday-Friday from 8:00am-4:30pm at our Percival Rd location with potential WFH opportunities.

What You Will Do:

• Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. 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 promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

To Qualify for This Position, You Will Need:

• High School Diploma or equivalent

• 1 year of experience in a claims/appeals processing, customer service, or other related support area 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.

• Microsoft Office.

What We Prefer:

• Previous claims processing 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 Expect Next:

After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requiremen