Legal Marketing and Case Support Specialist
Job Duck
Claims Customer Service Advocate II - Hybrid
BlueCross BlueShield of South Carolina
full-time
Posted on:
Location: South Carolina • 🇺🇸 United States
Visit company websiteJob 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
