FCMB Claims Customer Service Advocate II (Part-time)

BlueCross BlueShield of South Carolina•Myrtle Beach, SC

35d•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. Description Logistics - PGBA one of BlueCross BlueShield's South Carolina subsidiary companies. Location: This position is part-time (20 hours/week) Monday, Tuesday, Thursday and Friday from 12PM-5PM and will be on-site in Myrtle Beach, SC. Government Clearance : This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. SCA Benefit Requirements : BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamara-O'Hara Service Contract Act (SCA), employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.

Requirements

High School Diploma or equivalent
2 years of customer service experience OR 1 year of claims or appeals processing experience and 1 year of customer service 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 proficiency.
Ability to handle confidential or sensitive information with discretion.
Microsoft Office.
This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

Responsibilities

Research and respond to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
Research and respond to written inquiries and identify incorrectly processed claims and complete the adjustment and/or reprocessing action according to department guidelines. This may include initiating, documenting, and processing the request to completion.
Initiate recoupments as necessary.
Identify complaints and inquiries of a complexity level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution.
Identifies and reports potential fraud and abuse situations.
Complete projects and/or assignments related to claims processing and customer service functions in the department.