Customer Service Advocate I

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Hybrid

About The Position

Provides prompt, accurate, thorough, and courteous responses to customer inquiries, conducting research as needed to resolve them. This full-time position is on-site in Columbia, South Carolina, in a typical office environment. The schedule is Monday through Friday, 40 hours per week, with flexibility to work any eight-hour shift scheduled between 8:00 a.m. and 5:00 p.m. Training is on-site Monday through Friday, 8:00 a.m. to 5:00 p.m., for approximately 8–10 weeks. Work from home may be considered after on-site training, based on performance and line-of-business needs. The position is not eligible for current or future sponsorship.

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 according to desk procedures while meeting 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 in accordance with 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.

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 at major locations.
Wellness program and healthy-lifestyle premium discount.
Tuition assistance.
Service recognition.
Employee assistance.
Discounts to movies, theaters, zoos, theme parks, and more. Benefits eligibility begins the first of the month following 28 days of employment.