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Claims Customer Service Advocate II

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BlueCross BlueShield of South Carolina

2mo ago

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

AI generated summary

  • You need a high school diploma, 2 years of customer service (1 year in claims), strong communication skills, basic math, and proficiency in Microsoft Office. An associate's degree is preferred.
  • You will address customer inquiries, process claims accurately, research complex issues, ensure compliance with standards, and report 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.
  • 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 is the job title for this position?

The job title is Claims Customer Service Advocate II.

What are the primary responsibilities of a Claims Customer Service Advocate II?

The primary responsibilities include responding to customer inquiries, reviewing and adjudicating claims and non-medical appeals, processing adjustments, and ensuring effective customer relations.

What are the educational requirements for this position?

A high school diploma or equivalent is required. An associate degree or a bachelor's degree in lieu of work experience is preferred.

How much customer service experience is required for this role?

A minimum of 2 years of customer service experience, including at least 1 year of claims or appeals processing, is required.

What are the working hours for this position?

The position is full-time, Monday to Friday, with an 8-hour flexible shift during the hours of 8:00 am to 8:00 pm. Occasional overtime may be necessary.

Where is the job located?

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

What technical skills are required for this position?

Proficiency with Microsoft Office products is required.

What benefits are offered to employees in this role?

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

Is previous claims experience preferred for this position?

Yes, 1-2 years of claims experience and/or healthcare management experience is preferred.

How does the company handle equal employment opportunities?

The company maintains a policy of nondiscrimination and promotes employment opportunities regardless of age, race, gender, and other legally protected statuses, and complies with applicable laws and regulations.

What should I expect after submitting my application?

After submitting your application, the recruiting team will review your resume for qualifications, which may include a brief telephone interview or email communication, followed by interviews with management for qualifying candidates.

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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.