FCMB Claims Customer Service Advocate II

PGBA•Columbia, SC

3d•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. The role is with PGBA, a BlueCross BlueShield of South Carolina subsidiary, and is based on-site at 17 Technology Circle in Columbia, South Carolina. It is full-time, 40 hours per week, Monday through Friday, in a typical office environment. The schedule is an eight-hour shift during normal business hours of 8:00 AM to 6:00 PM. Occasional overtime may be necessary, and travel between buildings may be required. Training is on-site Monday through Friday, 8:00 AM to 5:00 PM, for approximately 8–10 weeks. The role requires the ability to obtain a security clearance, which requires U.S. citizenship. The position is not eligible for sponsorship now or in the future. As an SCA employee, the employee is required to enroll in the company’s health insurance, even if they have other health insurance. Supplemental pay for health coverage is provided until enrollment is complete; coverage begins on the first day of the month following 28 days of full-time employment. The employee researches and responds to inquiries, identifies and processes incorrectly handled claims, initiates recoupments when necessary, escalates complex matters, reports potential fraud and abuse, and completes related claims-processing and customer-service assignments. Benefits eligibility begins the first of the month following 28 days of employment.

Requirements

High school diploma or equivalent.
Two years of customer service experience; or one year of claims or appeals processing experience and one year of customer service experience; 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 handle confidential or sensitive information with discretion.
Microsoft Office skills.
Ability to obtain a security clearance; applicants must be U.S. citizens.
Must enroll in the company’s health insurance as an SCA employee.
Must be able to work on-site in Columbia, South Carolina; occasional travel between buildings and overtime may be necessary.

Responsibilities

Research and respond to telephone inquiries according to desk procedures, meeting contract standards and objectives for timeliness, productivity, and quality.
Research and respond to written inquiries.
Identify incorrectly processed claims and complete adjustments and/or reprocessing according to department guidelines, including initiating, documenting, and processing requests to completion.
Initiate recoupments as necessary.
Identify complaints and inquiries too complex to resolve using desk procedures and guidelines, and refer them to a lead or manager.
Identify and report potential fraud and abuse situations.
Complete projects and assignments related to claims processing and customer service functions in the department.