Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

4d•Onsite

About The Position

The Claims Customer Service Advocate II responds to routine written correspondence and telephone inquiries about claims and appeals. The role identifies incorrectly processed claims and carries out adjustments and related reprocessing actions. It examines and processes claims and non-medical appeals in accordance with business and contract regulations, internal standards, and examining guidelines; enters claims into the claim system after verifying procedure and diagnosis coding; and helps ensure claims meet quality and production standards. Complex inquiries or complaints that cannot be resolved using desk procedures are referred to a lead or manager. Suspected fraud and system errors are promptly reported or referred to the appropriate departments. This full-time position is with PGBA, a subsidiary of BlueCross BlueShield of South Carolina, and is located on-site at 17 Technology Circle in Columbia, South Carolina. The schedule is Monday through Friday, 40 hours per week, in an eight-hour shift scheduled during normal business hours of 8:00 a.m. to 6:00 p.m. Occasional overtime may be necessary, and travel between buildings may be required. Initial training is on-site, Monday through Friday from 8:00 a.m. to 5:00 p.m., for approximately six to eight weeks. Applicants must be U.S. citizens and able to obtain a security clearance. Sponsorship is not available now or in the future. Because the subsidiary holds federal contracts subject to the Service Contract Act, employees are required to enroll in health insurance benefits regardless of other insurance coverage. Employees receive supplemental pay until enrolled in health benefits 28 days after their hire date. Benefits participation begins the first of the month following 28 days of employment.

Requirements

High school diploma or equivalent.
One year of experience, including one year in claims or appeals processing, customer service, or another related support area; a bachelor's degree may be substituted for 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.
U.S. citizenship and ability to obtain a security clearance.

Nice To Haves

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

Responsibilities

Respond to written and telephone inquiries about claims or appeals according to desk procedures and contract standards for timeliness, productivity, and quality.
Document inquiries accurately.
Identify incorrectly processed claims and complete 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 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 to a lead or manager.
Promptly report or refer suspected fraudulent activity and system errors to the appropriate departments.

Benefits

Subsidized health plans.
Dental coverage.
Vision coverage.
401(k) retirement savings plan with company match.
Life insurance.
Paid time off.
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 enrolled in health benefits 28 days after hire, as described under SCA benefit requirements.