Customer Service Advocate III

BlueCross BlueShield of South Carolina

Customer Service Advocate III processing complex health insurance claims and appeals for BlueCross BlueShield of South Carolina. Researching issues, detecting fraud, and supporting claims representatives.

Posted 8/5/2026full-timeColumbia • South Carolina • 🇺🇸 United StatesMid-LevelSeniorWebsite

Core Competencies

Role fit

Core Competencies

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Demonstrates expertise in claims processing and customer service, with a strong focus on resolving complex inquiries and maintaining compliance with regulations. Proficient in database software and capable of training customer service representatives while ensuring quality standards are met.

Highest-signal resume keywords

Claims Processing ExperienceCustomer Service SkillsVerbal And Written Communication SkillsKnowledge Of Database SoftwareAbility To Handle Confidential Information

ATS Keywords

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Applicant Tracking System Keywords

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Hard Skills

Claims ProcessingAppeals ProcessingBasic Business MathFraud DetectionProcedure And Diagnosis Coding

Soft Skills

Strong Customer Service SkillsAbility To PersuadeNegotiation SkillsAttention To Detail

Tools & Technologies

CohereGenesysBluesteps

Industry Keywords

ACA ExperienceQuality StandardsTimelinessProductivityPolicy Improvements

About the role

Key responsibilities & impact

Review claims or appeals issues, complaints, and complex inquiries referred by claims customer service representatives
Research causes of issues and identify ways to prevent and correct them
Identify and report potential fraud and abuse situations
Research and respond to complex customer inquiries while meeting timeliness, productivity, and quality standards
Examine and process claims and non-medical appeals according to regulations, internal standards, and guidelines
Enter claims into the claim system after verifying procedure and diagnosis coding
Ensure claims meet established quality and production standards
Provide management feedback regarding customer issues
Maintain accurate issue records
Follow complaints through resolution or report them to management
Maintain knowledge of procedures and policies
Recommend procedure and policy improvements
Assist in training claims customer service representatives

Requirements

What you’ll need

High School Diploma or equivalent required
3 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 abilities
Ability to handle confidential or sensitive information with discretion
1 year of ACA experience preferred
3 years of customer service or claims processing experience preferred
Associate degree in any major preferred
Ability to persuade, negotiate, or influence
Knowledge of database software
Experience with Cohere, Genesys, and Bluesteps preferred
Flexibility to work any 8-hour shift scheduled between 8:00 AM and 6:00 PM, Monday-Friday
Must work full-time, 40 hours per week
Position is not eligible for sponsorship now or in the future

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
Reasonable accommodations for disabilities, pregnancy-related conditions, and sincerely held religious beliefs
Pay difference coverage for full-time National Guard or Reserves employees called to active duty