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FCMB Claims Customer Service Advocate II

Columbia, South Carolina

Full-time

Onsite

Entry Level

1+ years exp

BlueCross BlueShield of South Carolina is a healthcare organization seeking a Claims Customer Service Advocate II. The role involves responding to inquiries regarding claims or appeals, processing claims, and identifying issues related to claims processing.

Computer Software

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