FCMB Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

1d•Onsite

About The Position

Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. This role involves researching and responding to telephone and written inquiries, identifying and correcting incorrectly processed claims, and initiating recoupments as necessary. Complex issues are escalated to a lead or manager, and potential fraud is reported. The position also includes completing projects related to claims processing and customer service functions.

Requirements

High School Diploma or equivalent
2 years of customer service experience OR 1 year of claims or appeals processing experience and 1 year of customer service experience 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 handle confidential or sensitive information with discretion.
Microsoft Office

Responsibilities

Research and respond to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
Research and respond to written inquiries and identify incorrectly processed claims and completes the adjustment and/or reprocessing action according to department guidelines. This may include initiating, documenting, and processing the request to completion. Initiate recoupments as necessary.
Identify complaints and inquiries of a complexity level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations.
Complete projects and/or assignments related to claims processing and customer service functions in the department.