Claims Customer Service Advocate II
- BlueCross BlueShield of South Carolina
- Columbia, SC
- Full Time
- About 17 hours ago
Salary
N/A
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Job Description
Summary
Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description
Logistics: This position is full-time (40 hours/week), Monday-Friday, in a typical office environment located at 4101 Percival Rd, Columbia, SC, 29229. Shift based upon business needs
What You Will Do
- Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written web, or walk-in inquiries. Handle situations that may require adaptation of response or extensive research. Identify incorrectly processed claims and process adjustments and reprocessing actions according to department guidelines.
- Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards, and examining guidelines. Enter claims into the claim system after verifying the correct coding of procedures and diagnosis codes. Ensure claims are processed according to established quality and production standards.
- Identify complex complaints and inquiries that cannot be resolved following desk procedures and guidelines and refer them to a lead or manager for resolution. Identify and report potential fraud and abuse situations.
To qualify for this position, you will need :
- A High School Diploma or equivalent
- 2 years of Customer service experience including 1-year claims OR appeals processing OR bachelor’s degree in lieu of work experience.
- 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.
- Microsoft Office.
What We Can Do for You
You are not alone. We are here to support you:
Our comprehensive benefits package includes:
- 401(k) retirement savings plan with company match
- Subsidized health plans and free vision coverage
- Life insurance
- Paid annual leave – the longer you work here, the more you earn.
- Nine paid holidays
- On-site cafeterias and fitness centers in major locations
- Wellness programs and healthy lifestyle premium discount
- Tuition assistance
- Service recognition
What to Expect Next
After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with a recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with those candidates who qualify, 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.
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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. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
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