FCMB Claims Customer Service Advocate II

PGBA, • Columbia, SC

75d

About The Position

Logistics: PGBA – is a subsidiary company of BlueCross BlueShield of South Carolina. Location: This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility work any our 8-hour shift scheduled during hours of 10AM –7PM. Training will be Monday – Friday 8:00 AM - 4:30/5:00 PM for approximately 6-8 weeks. This role is located on site at 17 Technology Circle, Columbia SC. Government Clearance: This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen.

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.
• Required Software and Tools: 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.

Benefits

• Subsidized health plans, dental and vision coverage.
• 401K retirement savings plan with company match.
• Life Insurance.
• Paid Time Off (PTO).
• On-site cafeterias and fitness centers in major locations.
• Wellness program and healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.
• Employee Assistance.
• Discounts to movies, theaters, zoos, theme parks and more.

What This Job Offers

• Job Type: Full-time
• Career Level: Entry Level
• Education Level: High school or GED
• Number of Employees: 5,001-10,000 employees