FCMB Customer Service Advocate II

BlueCross BlueShield of South Carolina • Florence, SC

4d • Onsite

About The Position

The FCMB Customer Service Advocate II proactively resolves members’ and providers’ questions and concerns using computer-based resources. The role responds to telephone, written, web, and walk-in inquiries, explains healthcare benefits, addresses claim concerns, and helps members and providers find doctors. Some inquiries require extensive research and collaboration with other departments. Accurate documentation is essential. The employee serves as a subject matter expert and may contribute recommendations, process improvements, and special projects. After mastering the role, the employee may train and share knowledge with new team members.

This is a full-time, 40-hour-per-week position at PGBA, located at 200 North Dozier Boulevard, Florence, South Carolina, in a typical office environment. The schedule is Monday through Friday, with flexibility to work any scheduled eight-hour shift during normal business hours. Occasional overtime and weekend work may be necessary.

As a Service Contract Act employee, enrollment in the company’s health insurance is required, even if the employee has other coverage. Until enrollment is complete, supplemental pay for health coverage is provided. Coverage begins on the first day of the month following 28 days of full-time employment. This position is not eligible for sponsorship now or in the future.

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.
• Flexibility to work any scheduled eight-hour shift during normal business hours.
• Ability to work occasional overtime and weekends when business needs require.
• Enrollment in the company’s health insurance is required for employees covered by the Service Contract Act.
• Must not require employment sponsorship now or in the future.

Nice To Haves

• Strong human relations and organizational skills.
• Demonstrated ability to handle high-stress, intense situations and conversations.
• Good judgment and ability to handle confidential or sensitive information with discretion.
• Ability to learn.

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 adjustment or reprocessing actions according to department guidelines, including initiating, documenting, and processing requests to completion.
• Initiate recoupments as necessary.
• Identify complex complaints and inquiries that cannot be resolved using desk procedures 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.
• Accurately document members’ and providers’ questions and concerns.
• Explain benefits, address claim concerns, and help members and providers find a doctor through telephone calls, online chats, or email.
• Collaborate with other departments when needed to research and resolve inquiries.
• Provide recommendations, feedback, process-improvement ideas, and assistance with special projects.
• Train and share knowledge with new team members after mastering the role.

Benefits

• Subsidized health plans
• Dental coverage
• Vision coverage
• 401(k) retirement savings plan with company match
• Life insurance
• Paid time off (PTO)
• On-site cafeterias and fitness centers in major locations
• Education assistance
• Service recognition
• National discounts to movies, theaters, zoos, theme parks, and more
• Supplemental pay for health coverage until required health insurance enrollment is complete

What This Job Offers

• Job Type: Full-time
• Career Level: Mid Level
• Education Level: High school or GED