Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

5d•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. Researches inquiries as needed to resolve them. The role is full-time, 40 hours per week, Monday through Friday, in a typical office environment at 4101 Percival Road, Columbia, South Carolina. The workday is an eight-hour shift scheduled 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, 8:00 AM to 5:00 PM, for approximately 8–10 weeks. The position is not eligible for sponsorship now or in the future.

Requirements

High school diploma or equivalent.
One year of experience, including one year in claims/appeals processing, customer service, or another related support area, or a 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.
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, meeting contract standards and objectives for timeliness, productivity, and quality.
Accurately document 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 guidelines, and refer them to a lead or manager.
Identify and promptly report and/or refer suspected fraudulent activities and system errors to the appropriate departments.