Logo of Huzzle

Home

Matches

Explore

Manage

Claims Customer Service Advocate II

image

BlueCross BlueShield of South Carolina

12d ago

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

AI generated summary

  • You need a high school diploma and 2 years of customer service experience (1 in claims) or a bachelor's degree. Proficient in MS Office, with strong communication and math skills.
  • You will handle customer inquiries, process claims and adjustments, verify coding, ensure quality standards, and refer complex issues while identifying potential fraud.

Requirements

  • Required Education:
  • High School Diploma or equivalent.
  • Required Work Experience:
  • 2 years of customer service experience including 1-year claims OR appeals processing 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:
  • Proficiency with Microsoft Office Products.
  • What Prefer That You Have The Following:
  • Associate degree
  • Prefer (2) years claims experience and/or Healthcare Management
  • 1-2 years in a healthcare environment, i.e. doctor office, hospital, urgent care, etc.
  • 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.

Responsibilities

  • Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
  • Handles situations which may require adaptation of response or extensive research.
  • 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 reports potential fraud and abuse situations.

FAQs

What are the working hours for this position?

This position is full-time (40 hours/week) with a flexible shift during the hours of 8:00 am – 8:00 pm, Monday to Friday.

Where is the job location for this role?

The job is located at 4101 Percival Road, Columbia, SC, 29203.

Is previous experience in claims processing required?

Yes, the position requires 2 years of customer service experience, including 1 year of claims or appeals processing, or a bachelor’s degree in lieu of work experience.

What type of education is required for this role?

A High School Diploma or equivalent is required; an Associate degree is preferred.

Are there opportunities for overtime in this role?

Yes, it may be necessary to work occasional overtime depending on business needs.

What types of inquiries will this position handle?

This position handles customer inquiries that may be non-routine and require deviation from standard procedures, including complex claims and appeals.

What benefits does the company offer?

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

What skills are necessary for this position?

Required skills include good verbal and written communication, strong customer service skills, proficiency in business math, and the ability to handle confidential information with discretion.

How can I get assistance if I need accommodations during the application process?

You can email mycareer.help@bcbssc.com or call 800-288-2227, ext. 47480 to request special assistance or accommodations.

Does the company have a policy for equal employment opportunity?

Yes, BlueCross BlueShield of South Carolina maintains a policy of nondiscrimination in employment and is committed to equal opportunities for all individuals.

image

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.