Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina

Claims Customer Service Advocate II at CGS/BlueCross BlueShield of South Carolina. Responsible for customer inquiries and claims processing in a hybrid work environment.

Posted 6/6/2026full-timeNashville • Tennessee • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Ensure effective customer relations by responding accurately, timely, and courteously to inquiries
Handle non-routine inquiries which may require adaptation of response or extensive research
Identify incorrectly processed claims and processes adjustments according to department guidelines
Examine and process claims and/or non-medical appeals according to business/contract regulations
Enter claims into the claim system after verification of correct coding
Ensure claims are processing according to established quality and production standards
Identify and report 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

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Applicant Tracking System Keywords

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Hard Skills & Tools

claims processingappeals processingcoding verificationbusiness math proficiency

Soft Skills

customer serviceverbal communicationwritten communicationattention to detaildiscretion

Certifications

High School DiplomaBachelor's Degree