Claims Customer Service Advocate II

BlueCross BlueShield of South Carolina

Claims Customer Service Advocate ensuring effective customer relations, handling inquiries and processing claims at BlueCross BlueShield of South Carolina. Located in Columbia, SC, flexible work options available.

Posted 6/19/2026full-timeColumbia • South Carolina • 🇺🇸 United StatesJuniorMid-LevelWebsite

About the role

Key responsibilities & impact

Ensures effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in 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 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.
Experience researching and processing Coordination of Benefits Claims.

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
Wellness program and healthy lifestyle premium discount
Tuition assistance
Service recognition
Employee Assistance
Discounts to movies, theaters, zoos, theme parks and more

ATS Keywords

✓ Tailor your resume

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 codesCoordination of Benefits Claimsbusiness math proficiency

Soft Skills

customer serviceverbal communicationwritten communicationadaptabilitydiscretion

Certifications

High School DiplomaBachelor's Degree