Claims Customer Service Advocate I

Summary

Position Purpose:

In the role as the Claims Customer Service Advocate I, the ideal candidate will be responsible for responding to routine inquiries. The Claims Customer Service Advocate I will also be responsible for identifying incorrectly processed claims, completes adjustments, and related reprocessing actions. The ideal candidate will review and adjudicate claims and/or non-medical appeals as well as determine whether to return, deny, or pay claims following organizational policies and procedures.

Description

Claims Customer Service Advocate I

Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we’ve been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina … and much more. We are one of the nation’s leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are dedicated to the same philosophy, consider joining our team!

Logistics

This position is full-time position (40 hours per week) Monday through Friday 7:30am – 4:00pm or 8:00am – 4:30pm reporting onsite to 4101 Percival Road, Columbia, SC 29219.

What You’ll Do

• Identify and promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments.
• Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes
• Respond to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met
• Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines
• Identify 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
• Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines
• Ensure claims are processing according to established quality and production standards
• Accurately documents inquiries

To Qualify For This Position, You’ll Need

• Microsoft Office
• Good verbal and written communication skills
• 1 year of experience in a claims/appeals processing, customer service, or other related support area OR Bachelor's Degree in lieu of work experience
• Ability to handle confidential or sensitive information with discretion
• Basic business math proficiency
• High School Diploma or equivalent
• Good spelling, punctuation, and grammar skills
• Strong customer service skills

What We Can Do For You

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

• Tuition assistance
• Service recognition
• 401K retirement savings plan with company match
• Paid Time Off (PTO)
• On-site cafeterias and fitness centers in major locations
• Wellness program and healthy lifestyle premium discount
• Discounts to movies, theaters, zoos, theme parks and more
• Employee Assistance
• Subsidized health plans, dental and vision coverage
• Life Insurance

What To Expect Next

After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements. If the qualifications require proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, with prioritization given to those candidates who demonstrate the preferred qualifications.

We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.

Equal Employment Opportunity Statement

BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.

We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.

If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.