Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

3d•Hybrid

About The Position

Provides prompt, accurate, thorough and courteous responses to all customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. National Alliance - one of BlueCross BlueShield's South Carolina subsidiary companies. This position is full time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility to work any of our 8-hour scheduled shifts during the hours of 8:00 AM –5:00 PM. Training will be Monday – Friday 8:00 AM - 4:30 PM for approximately 6-8 weeks. This role is W@H after training, equipment issuance and performance elation and LOB business needs review. Located at 4101 Percival Road, Columbia SC. This position is not eligible for sponsorship now or in the future.

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.