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Claims Customer Service Advocate I

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BlueCross BlueShield of South Carolina

14d ago

  • Job
    Full-time
    Junior Level
  • Customer Relations
    Healthcare
  • 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, along with strong communication, math skills, and Microsoft Office proficiency.
  • You will respond to inquiries, process claims and appeals, ensure accuracy, document cases, refer complex issues to management, and report suspected fraud or system errors as needed.

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 is the job title for this position?

The job title is Claims Customer Service Advocate I.

What are the required working hours for this position?

This position is full-time (40 hours/week), Monday to Friday, with shifts scheduled during the hours of 8:00 AM to 8:00 PM.

Is this position remote or on-site?

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

What kind of training is provided for this position?

Training will be conducted Monday to Friday from 8:00 AM to 4:30/5:00 PM for approximately 6-8 weeks.

What kind of experience is needed for this job?

You need either 1 year of experience in claims/appeals processing, customer service, or a related support area, or a Bachelor's Degree in lieu of work experience.

Is a security clearance required for this position?

Yes, this position requires the ability to obtain a security clearance, which necessitates that applicants be U.S. Citizens.

What benefits are offered for this position?

Benefits include subsidized health plans, dental and vision coverage, a 401K retirement savings plan with company match, paid time off, and more.

When do employees become eligible for benefits?

Employees become eligible to participate in benefits on the first of the month following 28 days of employment.

What skills are required for applicants?

Applicants 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.

What software is needed for this position?

Proficiency in Microsoft Office is required for this position.

How can applicants expect to be contacted after submitting their application?

After submitting your application, the recruiting team will review resumes and may conduct a brief telephone interview or email communication to verify resume specifics and salary requirements.

What is the company’s policy on equal employment opportunity?

The company maintains a nondiscrimination policy to promote employment opportunities regardless of age, race, color, national origin, sex, religion, veteran status, disability, sexual orientation, gender identity, and other legally protected statuses.

Is there an accommodation process for applicants with disabilities?

Yes, the company is committed to providing reasonable accommodations for individuals with disabilities and those needing accommodations for sincerely held religious beliefs, as long as they do not impose an undue hardship on the company.

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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.