Claims Customer Service Advocate II
BlueCross BlueShield of South Carolina
full-time
Posted on:
Location Type: Office
Location: Columbia • South Carolina • United States
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About the role
- Responsible for responding to customer inquiries.
- Perform research as needed to resolve inquiries.
- Review and adjudicate claims and/or non-medical appeals.
- Determine whether to return, deny or pay claims following organizational policies and procedures.
- Ensure effective customer relations by responding accurately, timely, and courteously to inquiries.
- Handle situations which may require adaptation of response or extensive research.
- Identify incorrectly processed claims and process adjustments and reprocessing actions.
- Examine and process claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines.
- Enter claims into the claim system after verification of correct coding of procedures and diagnosis codes.
- Ensure claims are processing according to established quality and production standards.
- Identify complaints and inquiries of a complex level that cannot be resolved following desk procedures and guidelines and refer these to a lead or manager for resolution.
- Identify and report potential fraud and abuse situations.
Requirements
- 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
Applicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingappeals processingcoding proceduresdiagnosis codesbusiness math proficiency
Soft Skills
customer serviceverbal communicationwritten communicationattention to detaildiscretion
Certifications
High School DiplomaBachelor's Degree