Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

Provides prompt, accurate, thorough, and courteous responses to customer inquiries, which may be non-routine and require research or deviation from standard screens, scripts, and procedures. Responds to written and telephone inquiries, documents them accurately, and works to meet contract standards for timeliness, productivity, and quality. Examines and processes claims and non-medical appeals according to applicable business and contract regulations, internal standards, and examining guidelines. Identifies incorrectly processed claims and performs adjustments and reprocessing as directed. Refers complex complaints and inquiries that cannot be resolved using desk procedures to a lead or manager, and promptly reports suspected fraud or system errors to appropriate departments. This is a full-time, on-site position at 4101 Percival Road in Columbia, South Carolina. The schedule is Monday through Friday, 40 hours per week, with 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 on-site Monday through Friday, 8:00 AM to 5:00 PM, for approximately 8–10 weeks. The position is not eligible for current or future sponsorship.

Requirements

High school diploma or equivalent.
One year of work experience, including one year in claims/appeals processing, customer service, or another related support area; a bachelor's degree may be substituted for the 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

Six months of BlueVue experience.
Six months of Population Health experience.
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 customer inquiries according to desk procedures and meet contract standards for timeliness, productivity, and quality.
Accurately document customer inquiries.
Research inquiries as needed to resolve them.
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.
Refer complex complaints and inquiries that cannot be resolved under desk procedures and guidelines to a lead or manager.
Promptly report or refer suspected fraudulent activities and system errors to the appropriate departments.