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BlueCross BlueShield of South Carolina · 1 month ago

Claims Customer Service Advocate II

Columbia, SC

Full-time

Onsite

Entry, Mid Level

2+ years exp

BlueCross BlueShield of South Carolina is the largest insurance company in South Carolina and a leading administrator of government contracts. They are seeking a Claims Customer Service Advocate II to respond to customer inquiries, adjudicate claims, and ensure effective customer relations while adhering to organizational policies and procedures.

Financial ServicesHealth CareHealth InsuranceInsuranceMedical

Responsibilities

You'll ensure effective customer relations by responding accurately, timely and courteously to our customers. These responses may be by telephone, written, web or walk-in inquiries. You will handle situations which may require a different set of responses or extensive research. Adhering to department guidelines, you will also identify claims that have been incorrectly processed and will enact process adjustments and reprocessing actions

You will examine and process claims and/or non-medical appeals while ensuring business/contract regulations, internal standards and examining guidelines. Another responsibility is to enter claims into the claim system after verifying correct coding of procedures and diagnosis codes. Claims must be processed according to established quality and production standards

You'll identify complaints and inquiries that may be complex and that cannot be resolved following usual procedures and guidelines and refer to a team lead or manager for resolution. You will also identify and report fraud and abuse situations

Qualification

Claims processingCustomer serviceMicrosoft OfficeBusiness mathVerbal communicationWritten communicationConfidentiality

Required

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

Preferred

Provider Customer Service Experience

Benefits

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 a healthy lifestyle premium discount.

Tuition assistance.

Service recognition.

Company

BlueCross BlueShield of South Carolina

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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