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Claims Customer Service Advocate I

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BlueCross BlueShield of South Carolina

16d ago

  • Job
    Full-time
    Junior Level
  • Customer Relations
    Logistics
  • Columbia, +1
  • Quick Apply

AI generated summary

  • You need a high school diploma or equivalent, 1 year in claims/customer service or a Bachelor's degree, strong communication and math skills, and proficiency in Microsoft Office.
  • You will handle inquiries, process and examine claims, document actions, refer complex issues, and report fraud while adhering to quality and productivity standards.

Requirements

  • * Required Education:
  • * High School Diploma or equivalent
  • * Required Work Experience:
  • * 1 year of experience in claims/appeals processing, customer service, or other related support area OR Bachelor's Degree in lieu of work experience.
  • * Required Skills and Abilities:
  • * 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.
  • * Required Software and Tools:
  • * Microsoft office

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. Ensure claims are processed 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.

FAQs

What are the working hours for the Claims Customer Service Advocate I position?

The position requires full-time availability, Monday through Friday, with an 8-hour shift scheduled during the hours of 8:00 AM to 8:00 PM.

Where is the position located?

The role is located on-site at 17 Technology Circle, Columbia, SC.

Is training provided for this role?

Yes, training is provided Monday through Friday from 8:00 AM to 4:30/5:00 PM for approximately 6-8 weeks.

What qualifications are required for this position?

A high school diploma or equivalent is required, along with either 1 year of experience in claims/appeals processing, customer service, or related support, or a Bachelor's Degree in lieu of work experience.

Are there any specific skills required for this role?

Yes, candidates should have good verbal and written communication skills, strong customer service skills, basic business math proficiency, and the ability to handle confidential information with discretion.

Does this position require U.S. citizenship?

Yes, this position requires applicants to be U.S. Citizens to obtain a security clearance.

What benefits are offered to employees?

The benefits include subsidized health plans, dental and vision coverage, a 401K retirement savings plan with company match, life insurance, paid time off (PTO), tuition assistance, and more.

How does the organization view diversity and inclusion?

The organization values a diverse and inclusive workplace and is committed to providing opportunities for employees from all backgrounds to develop their skills and advance their careers.

What should I expect after submitting my application?

After submitting your application, the recruiting team will review your resume and may conduct a brief telephone interview or email communication to verify specific details before management conducts interviews with qualified candidates.

Is reasonable accommodation available for individuals with disabilities during the hiring process?

Yes, the organization is committed to working with individuals needing reasonable accommodations for disabilities and other requests, made on a case-by-case basis.

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BlueCross BlueShield of South Carolina

South Carolina’s largest and oldest health insurance company

Finance
Industry
10,001+
Employees
1946
Founded Year

Mission & Purpose

BlueCross BlueShield of South Carolina, the state's largest insurance company, has been a part of the national landscape for over six decades. With an A+ Superior rating from A.M. Best, the company is a leading government contract administrator and operates one of the most advanced data processing centers in the Southeast. BlueCross offers employees robust benefits, including retirement plans, health coverage, and education assistance, while fostering a culture of community support, with employees actively contributing to numerous nonprofit organizations each year.