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BlueCross BlueShield of South Carolina · 10 hours ago

FCMB Claims Customer Service Advocate II

Florence, SC

Full-time

Onsite

Entry Level

1+ years exp

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II. The role is responsible for responding to inquiries related to claims or appeals and processing adjustments for incorrectly processed claims.

Financial ServicesHealth CareHealth InsuranceInsuranceMedical

No H1B

Security Clearance Required

U.S. Citizen Only

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

Qualification

Claims ProcessingCustomer ServiceMicrosoft OfficeBusiness MathVerbal CommunicationWritten CommunicationConfidentiality Management

Required

A High School Diploma or equivalent

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

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

Microsoft Office

Preferred

Associate degree

(2) years-of claims processing or call center experience

Knowledge of word processing, spreadsheet, and database software

Benefits

Subsidized health plans, dental and vision coverage

401K retirement savings plan with company match

Life Insurance

Paid Time Off (PTO)

On-site cafeterias and fitness centers in major locations

Wellness program and healthy lifestyle premium discount

Tuition assistance

Service recognition

Employee Assistance

Discounts to movies, theaters, zoos, theme parks and more

Company

BlueCross BlueShield of South Carolina

Glassdoor3.6

For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state.

Founded in 1946

Columbia, South Carolina, USA

10001+ employees