Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

12h•Onsite

About The Position

This role directly helps our customers in a timely, prompt, thorough, courteous and accurate way to answer some of their most worrisome health care questions and concerns. This job can be complex and may require research as well as the ability to feel comfortable going off script to ensure our customers’ questions are answered correctly, the first time.

Requirements

A High School Diploma or equivalent
1-year of experience including 1-year claims/appeals processing, customer service, or other related support area OR bachelor’s degree 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.

Nice To Haves

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

Responsibilities

Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
Accurately documents inquiries.
Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes.
Ensures claims are processing according to established quality and production standards.
Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution.
Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.