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FCMB Claims Customer Service Advocate II

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BlueCross BlueShield of South Carolina

13d 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 of claims or customer service experience, strong communication skills, and proficiency in Microsoft Office. An associate degree is preferred.
  • You will handle inquiries by phone and in writing, process claims, document actions, resolve complex issues, and report fraudulent activities while ensuring adherence to quality standards.

Requirements

  • Required Education:
  • A High School Diploma or equivalent
  • Required Work Experience:
  • 1-year of experience including 1-year 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 Manage Confidential or Sensitive Information with Discretion.
  • Required Software and Tools:
  • Microsoft Office.
  • Preferred Qualifications:
  • Associate degree
  • (2) years-of claims processing or call center experience.
  • Knowledge of word processing, spreadsheet, and database software.

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. 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 promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.

FAQs

What is the work schedule for the FCMB Claims Customer Service Advocate II position?

The position is full-time at 40 hours per week, Monday to Friday, with shifts scheduled during the hours of 8:00 AM to 5:00 PM.

Is training provided for this role?

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

Is this position on-site or remote?

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

What are the educational requirements for this position?

A High School Diploma or equivalent is required. Alternatively, a bachelor’s degree can be substituted for work experience.

How much work experience is required for this role?

Applicants need at least 1 year of experience in claims/appeals processing, customer service, or a related support area.

What skills are necessary for this job?

Required skills include good verbal and written communication, strong customer service abilities, proficiency in basic business math, and the ability to manage confidential information discreetly.

Are there any preferred qualifications for this position?

Yes, an associate degree and 2 years of claims processing or call center experience are preferred.

What kind of benefits does the company offer?

The company offers subsidized health plans, dental and vision coverage, a 401K retirement plan with company match, life insurance, paid time off, tuition assistance, and various discounts among other benefits.

What is the company’s stance on diversity and inclusion in the workplace?

The company is committed to creating a diverse and inclusive workplace and provides opportunities for employees across all spectrums to develop their skills and advance their careers.

How does the application process work?

After submitting your application, the recruiting team will review your resume. If qualified, you may have a brief telephone interview or email communication, followed by interviews with management for selected candidates.

Does this position require a security clearance?

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

Are there accommodations available for individuals with disabilities?

Yes, the company is committed to working with individuals requiring reasonable accommodations for disabilities, pregnancy-related conditions, or sincerely held religious beliefs 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.