BlueCross BlueShield of South Carolina

Claims Customer Service Advocate II - Hybrid

BlueCross BlueShield of South Carolina

full-time

Posted on:

Origin:  • 🇺🇸 United States • South Carolina

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Job Level

JuniorMid-Level

About the role

  • Responds to customer inquiries via telephone, written, web, or walk-in inquiries
  • Performs research as needed to resolve inquiries
  • Reviews and adjudicates claims and/or non-medical appeals
  • Determines whether to return, deny or pay claims following organizational policies and procedures
  • 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
  • Location: On-site at 4101 Percival Road, Columbia SC; Full-time schedule with 8-hour shifts 8:00 AM–8:00 PM; Training 8:00 AM - 4:30 PM for ~6-8 weeks

Requirements

  • High School Diploma or equivalent required
  • 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 proficiency