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BlueCross BlueShield of South Carolina · 3 weeks ago

Bilingual Customer Service Advocate II

Columbia, SC

Full-time

Onsite

Entry, Mid Level

2+ years exp

BlueCross BlueShield of South Carolina is a healthcare organization seeking a Bilingual Customer Service Advocate II. The role involves responding to customer inquiries, processing claims, and ensuring effective customer relations while adhering to organizational policies and procedures.

Financial ServicesHealth CareHealth InsuranceInsuranceMedical

Responsibilities

Ensure 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

Examine and process 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. Ensure claims are processing according to established quality and production standards

Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations

Qualification

Claims processingBilingual SpanishBilingual EnglishCustomer service experienceMicrosoft OfficeBusiness math proficiencyCommunication skillsConfidentiality handling

Required

High School Diploma or equivalent

Must be able to speak Spanish and English fluently

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

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

Education Assistance

Service Recognition

National 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