Customer Service Advocate

Blue Cross and Blue Shield of North Carolina•Remote Flex - North Carolina, NC

3d•$41,600 - $66,561

About The Position

The Customer Service Advocate embodies Blue Cross NC’s service vision, objectives, and values, serving as a service expert for customers, employer groups, and providers. The role strengthens the Blue Cross NC brand by developing and managing customer relationships and delivering service that meets or exceeds expectations. The advocate responds accurately, promptly, and professionally to stakeholders, aiming for customer satisfaction and first-contact resolution across channels such as phone and chat. The position supports customer education and resolution of routine and complex inquiries involving benefits, claims, eligibility, and health care decisions. It also helps customers use online and mobile tools, contributes ideas for process improvement, engages with government entities and plan participants, and may serve as a subject matter expert or mentor to teammates.

Requirements

High school diploma or GED.
At least 3 years of experience in a related field.

Nice To Haves

Hands-on Facets experience.
Strong customer or member service orientation.
Knowledge of benefits and eligibility.
Strong claims knowledge, including the ability to review a claim and connect it to applicable benefits.
IPP experience; preferred but not required.

Responsibilities

Engage with providers, billing teams, case managers, and other stakeholders to resolve customer concerns and explain benefits, claims, and eligibility.
Conduct customer training sessions at employer sites and facilitate online education sessions.
Support complex customer inquiries, including serious health conditions and complex claims or benefit issues.
Screen members for case management needs and use administrative or clinical resources when needed.
Adjust simple or routine claims when supporting providers.
Provide inbound and outbound inquiry support across multiple channels.
Use probing and creative problem-solving techniques to diagnose and resolve member or provider issues.
Help customers navigate online and mobile tools and encourage self-sufficiency.
Educate customers about benefit plan selections, maximizing health plan benefits, and choosing quality care providers.
Explain customers’ next-best options to help members make informed health decisions.
Contribute ideas and support continuous process improvement.
Engage with local, state, and federal government entities and plan participants regarding products, services, and policies.
Serve as a subject matter expert or mentor to team members handling non-routine inquiries.
Query, analyze, and interpret data to address customer and business needs.