Customer Service Advocate I

BlueCross BlueShield of South Carolina•Columbia, SC

3d•Hybrid

About The Position

The Customer Service Advocate I provides prompt, accurate, thorough, and courteous responses to customer inquiries, conducting research as needed to resolve them. The role is full-time, 40 hours per week, Monday through Friday, in a typical office environment at 4101 Percival Road, Columbia, South Carolina. Employees must be available to work any scheduled eight-hour shift between 8:00 AM and 5:00 PM. Initial training is onsite, Monday through Friday from 8:00 AM to 5:00 PM, for approximately 8–10 weeks. After training, work-from-home may be considered based on performance and line-of-business needs. The position responds to written and telephone inquiries, documents customer interactions, examines and processes claims and non-medical appeals, and handles claim adjustments and reprocessing when needed. It also identifies issues requiring escalation and promptly reports suspected fraud or system errors. The role is not eligible for sponsorship now or in the future.

Requirements

High school diploma or equivalent.
One year of experience, including one year in claims/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 manage confidential or sensitive information with discretion.
Microsoft Office skills.

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/or telephone inquiries in accordance with desk procedures and meet contract standards and objectives for timeliness, productivity, and quality.
Accurately document inquiries.
Identify incorrectly processed claims and process adjustments and reprocessing actions 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 correct procedure and diagnosis coding.
Ensure claims are processed according to established quality and production standards.
Identify complex complaints and inquiries that cannot be resolved using desk procedures and guidelines, and refer them to a lead or manager.
Identify and promptly report or refer suspected fraudulent activities and system errors to the appropriate departments.