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Customer Service Advocate II
BlueCross BlueShield of South CarolinaCustomer Service Advocate addressing customer inquiries and claims for BlueCross BlueShield in a hybrid role. Collaborating with team members to ensure effective customer relations and accurate claims processing.
About the role
Key responsibilities & impact- Provides prompt, accurate, thorough and courteous responses to all customer inquiries
- Handles situations which may require adaptation of response or extensive research
- 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 reports potential fraud and abuse situations
Requirements
What you’ll need- 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
Benefits
Comp & perks- 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
- Education Assistance
- Service Recognition
- National discounts to movies, theaters, zoos, theme parks and more
ATS Keywords
✓ Tailor your resumeApplicant Tracking System Keywords
Tip: use these terms in your resume and cover letter to boost ATS matches.
Hard Skills & Tools
claims processingappeals processingcoding of proceduresdiagnosis codesbusiness math proficiency
Soft Skills
customer serviceverbal communicationwritten communicationattention to detaildiscretion
Certifications
High School DiplomaBachelor's Degree