Customer Service Advocate III

BlueCross BlueShield of South Carolina•Columbia, SC

2d•Hybrid

About The Position

Provides prompt, accurate, thorough and courteous responses to all complex customer inquiries. Inquiries are typically non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. This position is full-time (40-hours/week) Monday-Friday in a typical office environment. You will work an 8-hour shift scheduled during our normal business hours 8am-6pm. It may be necessary, given the business need to work occasional overtime. You may be required to travel between buildings. This role is located at 4101 Percival Road, Columbia SC. This is a HYBRID position. Your ability to work HYBRID will be dependent upon performance review/evaluation and LOB needs. This position is not eligible for sponsorship now or in the future.

Requirements

High School Diploma or equivalent
3 years of customer service experience, including 1 year of claims or appeals processing 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 abilities.
Ability to handle confidential or sensitive information with discretion.

Nice To Haves

3 Years-Customer service or claims processing experience.
Associate degree-Any Major
Ability to persuade, negotiate or influence.
Knowledge of database software.
Cohere Experience, Genesys, and Bluesteps.

Responsibilities

Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed. Research to identify cause and mine ways to prevent and correct such causes.
Identifies and reports potential fraud and abuse situations.
Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity and quality are met. Handles situations that require adaptation of response or extensive research.
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. Ensure claims are processed according to established quality and production standards.
Provide feedback to management regarding customer issues.
Maintain accurate records concerning issues.
Follow through on complaints until resolved or report to management as needed.
Maintain knowledge of procedures and policies.
Assist with process improvements by recommending improvements in procedures and policies.
Assists in training claims customer service representatives.