Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

9h•Onsite

About The Position

National Alliance, a BlueCross BlueShield of South Carolina subsidiary, is hiring a Claims Customer Service Advocate II in Columbia, South Carolina. The role responds to customer inquiries, including non-routine matters that may require research or adaptation of standard screens, scripts, and procedures. It also reviews and adjudicates claims and non-medical appeals, determining whether claims should be returned, denied, or paid under organizational policies and procedures. This is a full-time, 40-hour-per-week position, Monday through Friday, in a typical office environment. Employees must be flexible to work scheduled eight-hour shifts between 8:00 AM and 5:00 PM. Training is Monday through Friday, 8:00 AM to 4:30 PM, for approximately six to eight weeks. The role may be reviewed for work-from-home after equipment issuance, training completion, performance review, and evaluation of line-of-business needs. The work location is 4101 Percival Road, Columbia, SC. This position is not eligible for sponsorship now or in the future.

Requirements

High school diploma or equivalent.
Two years of customer service experience, including one year of claims or appeals processing experience, 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.
Microsoft Office.

Nice To Haves

Associate degree.
Two years of claims processing or call center experience.
Knowledge of word processing, spreadsheet, and database software.

Responsibilities

Respond accurately, promptly, and courteously to customer inquiries by telephone, in writing, online, or in person, researching or adapting responses when needed.
Identify incorrectly processed claims and process adjustments and reprocessing actions according to department guidelines.
Examine and process claims and non-medical appeals according to business and contract regulations, internal standards, and examining guidelines.
Enter claims into the claim system after verifying 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 report potential fraud and abuse situations.