Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

6d•Onsite

About The Position

The Customer Service Advocate II provides prompt, accurate, thorough, and courteous responses to customer inquiries. Some inquiries may be non-routine and require research or deviation from standard screens, scripts, and procedures. The position responds to written and telephone inquiries, documents them accurately, and works to meet contract standards for timeliness, productivity, and quality. It also examines and processes claims and non-medical appeals, identifies and corrects claims processing issues, and refers complex inquiries, suspected fraud, and system errors to the appropriate lead, manager, or department. This is a full-time, on-site position at 4101 Percival Road in Columbia, South Carolina, working 40 hours per week, Monday through Friday. The schedule is 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, from 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 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 inquiries according to desk procedures, meeting contract standards and objectives for timeliness, productivity, and quality.
Accurately document customer 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 that procedure and diagnosis codes are correct.
Ensure claims are processed according to established quality and production standards.
Identify complex complaints and inquiries that cannot be resolved using desk procedures and refer them to a lead or manager.
Identify and promptly report or refer suspected fraudulent activity and system errors to the appropriate departments.