Claims Customer Service Advocate I

PGBA,•Columbia, SC

6d•Onsite

About The Position

PGBA, a subsidiary of BlueCross BlueShield of South Carolina, is hiring a Claims Customer Service Advocate I. This role responds to routine written and telephone inquiries, identifies incorrectly processed claims, and completes adjustments and related reprocessing actions. It reviews and adjudicates claims and non-medical appeals, determining whether claims should be returned, denied, or paid in accordance with organizational policies and procedures. The position is full-time, 40 hours per week, Monday through Friday, and is performed onsite at 17 Technology Circle in Columbia, South Carolina, in a typical office environment. Employees must be flexible to work an assigned eight-hour shift scheduled between 8:00 a.m. and 5:00 p.m. Training is Monday through Friday, 8:00 a.m. to 4:30 or 5:00 p.m., for approximately six to eight weeks. The role requires the ability to obtain a security clearance; applicants must be U.S. citizens. The position is not eligible for sponsorship now or in the future. As a federal contractor subject to the Service Contract Act, the company requires employees to enroll in health insurance benefits regardless of other coverage. Supplemental pay is provided until enrollment in health benefits 28 days after the hire date.

Requirements

High school diploma or equivalent.
One year of experience in claims/appeals processing, customer service, or another related support area, or a 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.
Ability to obtain a security clearance; applicants must be U.S. citizens.
Flexibility to work an assigned eight-hour shift scheduled between 8:00 a.m. and 5:00 p.m.

Responsibilities

Respond to written and/or telephone inquiries according to desk procedures and meet contract standards for timeliness, productivity, and quality.
Accurately document inquiries.
Identify incorrectly processed claims and process adjustments and reprocessing actions according to department guidelines.
Examine and process claims and/or non-medical appeals according to business and contract regulations, internal standards, and examining guidelines.
Enter claims into the claim system after verifying correct procedure and diagnosis coding.
Ensure claims are processed according to established quality and production standards.
Refer complex complaints and inquiries that cannot be resolved using desk procedures and guidelines to a lead or manager.
Identify and promptly report or refer suspected fraudulent activities and system errors to the appropriate departments.

Benefits

Subsidized health plans
Dental and vision coverage
401(k) retirement savings plan with company match
Life insurance
Paid time off (PTO)
On-site cafeterias and fitness centers in major locations
Wellness program and healthy lifestyle premium discount
Tuition assistance
Service recognition
Employee assistance
Discounts to movies, theaters, zoos, theme parks, and more
Supplemental pay until enrollment in health benefits 28 days after the hire date