Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina • Columbia, SC

2d • Onsite

About The Position

The Claims Customer Service Advocate II responds to customer inquiries, including non-routine matters that may require departing from standard screens, scripts, or procedures and conducting research. The role reviews and adjudicates claims and/or non-medical appeals, determining whether claims should be returned, denied, or paid in accordance with organizational policies and procedures.

This is a full-time, 40-hour-per-week, on-site position at 4101 Percival Rd, Columbia, SC 29229, with a Monday–Friday schedule. Employees may choose a schedule of 7:30 a.m.–4:00 p.m. or 8:00 a.m.–4:30 p.m. Training takes place over six months during regular business hours.

Requirements

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

Responsibilities

• Respond accurately, promptly, and courteously to customer inquiries by telephone, in writing, on the web, or in person.
• Adapt responses or conduct extensive research to handle situations that require it.
• Identify incorrectly processed claims and make adjustments or reprocess claims 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 the correct coding of procedures and diagnosis codes.
• Ensure claims meet established quality and production standards.
• Refer complex complaints and inquiries that cannot be resolved through desk procedures and guidelines to a lead or manager.
• Identify and report potential fraud and abuse situations.

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
• Education assistance
• Service recognition
• National discounts to movies, theaters, zoos, theme parks, and more

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED