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BlueCross BlueShield of South Carolina · 3 weeks ago

Claims Customer Service Advocate II

Columbia, SC

Full-time

Onsite

Entry, Mid Level

2+ years exp

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II responsible for responding to customer inquiries and adjudicating claims. The role involves performing research to resolve inquiries, processing claims according to regulations, and ensuring effective customer relations.

Financial ServicesHealth CareHealth InsuranceInsuranceMedical

Responsibilities

Ensures 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

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 reports potential fraud and abuse situations

Qualification

Customer service experienceClaims processingBusiness math proficiencyMicrosoft OfficeVerbal communicationWritten communicationConfidentiality

Required

High School Diploma or equivalent

2 years of customer service experience including 1 year of claims or appeals processing experience 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

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