Claims Customer Service Advocate I

BlueCross BlueShield of South Carolina•Greenville, 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. This position is full-time (40hours/week) Monday-Friday in a typical office environment. This role is located on-site at 1000 Executive Center Drive Greenville, SC 29616

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.
Microsoft Office
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.

Responsibilities

Respond 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.
Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
Examine and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.
Ensure claims are processing according to established quality and production standards.
Identify 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.
Identify and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.