FCMB Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina•Columbia, SC

19h•Onsite

About The Position

This position is for a Claims Customer Service Advocate II at PGBA, a subsidiary of BlueCross BlueShield of South Carolina. The role involves responding to routine correspondence and telephone inquiries related to claims or appeals, identifying incorrectly processed claims, and completing necessary adjustments and reprocessing actions. It is a full-time, on-site position located at 17 Technology Circle, Columbia SC, with a typical office environment. Employees are required to have flexibility to work any 8-hour shift scheduled between 10 AM and 7 PM, Monday-Friday, due to contractual obligations. Training will be Monday-Friday from 8:00 AM to 5:00 PM for approximately 6-8 weeks. The position requires the ability to obtain a security clearance, necessitating U.S. citizenship. As a federal contractor subject to the Service Contract Act (SCA), employees are required to enroll in health insurance benefits, receiving supplemental pay until enrollment 28 days after the hire date. The company emphasizes its long-standing presence, A+ (Superior) A.M. Best rating, and status as the largest insurance company in South Carolina, also being a leading administrator of government contracts and a strong supporter of veterans.

Requirements

A High School Diploma or equivalent
1-year of experience including 1-year claims/appeals processing, customer service, or other related support area 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 Manage Confidential or Sensitive Information with Discretion.
Microsoft Office.

Nice To Haves

Associate degree
(2) years-of claims processing or call center experience.
Knowledge of word processing, spreadsheet, and database software.

Responsibilities

Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met.
Accurately documents inquiries.
Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
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.
Ensures claims are processing according to established quality and production standards.
Identifies complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refers these to a lead or manager for resolution.
Identifies and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.