Claims Customer Service Advocate I

BlueCross BlueShield of South Carolina•Columbia, SC

4d•Onsite

About The Position

Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. BlueCross BlueShield of South Carolina has been part of the national landscape for more than seven decades, with its roots firmly embedded in the South Carolina community. It is the largest insurance company in South Carolina and a leading administrator of government contracts, operating a sophisticated data processing center. The company has a diverse family of subsidiary companies, allowing it to build on various business strengths and deliver outstanding service to its customers. This position is full-time (40-hours/week) Monday-Friday in a typical office environment, with an 8-hour shift from 8:00 AM – 5:00 PM, located onsite at 4101 Percival Road, Columbia, SC 29229. As a Service Contract Act (SCA) employee, enrollment in the company's health insurance is required, even if other coverage exists. Supplemental pay for health coverage is provided until enrollment is complete. Coverage begins on the first day of the month following 28 days of full-time employment.

Requirements

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.

Responsibilities

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 and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.