Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

3d•Onsite

About The Position

Provides prompt, accurate, thorough, and courteous responses to customer inquiries, which may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. The role is full-time, 40 hours per week, Monday through Friday, in a typical office environment at 4101 Percival Road in Columbia, South Carolina. The employee works an eight-hour shift during normal business hours of 8:00 AM to 5:00 PM. Occasional overtime may be necessary, and travel between buildings may be required. Training is onsite, Monday through Friday from 8:00 AM to 5:00 PM, for approximately 8–10 weeks. The position responds to written and telephone inquiries, documents them accurately, and works to meet contract standards and objectives for timeliness, productivity, and quality. It also examines and processes claims and non-medical appeals, enters claims after verifying procedure and diagnosis coding, and handles claim adjustments and reprocessing as appropriate. Complex complaints and inquiries are referred to a lead or manager. Suspected fraud and system errors are reported or referred to appropriate departments.

Requirements

High school diploma or equivalent, or a bachelor's degree in lieu of the stated work experience.
One year of experience, including one year in claims/appeals processing, customer service, or another related support area, unless a bachelor's degree is used 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 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 and meet contract standards for timeliness, productivity, and quality.
Accurately document customer 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 refer them to a lead or manager.
Identify and promptly report or refer suspected fraudulent activities and system errors to the appropriate departments.
Perform research as needed to resolve inquiries.