Claims Customer Service Advocate II
Summary
In the role as the Claims Customer Service Advocate II, the ideal candidate will be responsible for responding to routine inquiries. These inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. The Claims Customer Service Advocate II will perform research as needed to resolve inquiries. The ideal candidate will review and adjudicate claims and/or non-medical appeals as well as determine whether to return, deny, or pay claims following organizational policies and procedures.
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!
Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.
Description
Logistics:
This position will be onsite at 4101 Percival Rd. Columbia, SC 29229. Training hours will be 8:00 a.m. - 4:30 p.m. Monday - Friday. After training the hours will be between 8:00 a.m. - 6:00 p.m. Monday - Friday.
What You'll Do:
Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
Handle situations which may require adaptation of response or extensive research.
Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
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 refers these to a lead or manager for resolution.
Identify and report potential fraud and abuse situations.
To Qualify for This Position, You'll Need:
High School Diploma or equivalent
Two years of customer service experience including One 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.
We Prefer That You Have:
One year call center experience with claims experience.
What We can Do for You:
401K retirement savings plan with company match
Subsidized health plans, dental and vision coverage
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
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
Apply Now
In the role as the Claims Customer Service Advocate II, the ideal candidate will be responsible for responding to routine inquiries. These inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. The Claims Customer Service Advocate II will perform research as needed to resolve inquiries. The ideal candidate will review and adjudicate claims and/or non-medical appeals as well as determine whether to return, deny, or pay claims following organizational policies and procedures.
Why should you join the BlueCross BlueShield of South Carolina family of companies? Other companies come and go, but for more than seven decades we have been part of the national landscape, with our roots firmly embedded in the South Carolina community. We are the largest insurance company in South Carolina and much more. We are one of the nation's leading administrators of government contracts. We operate one of the most sophisticated data processing centers in the Southeast. We also have a diverse family of subsidiary companies that allows us to build on a variety of business strengths. We deliver outstanding service to our customers. If you are committed to the same philosophy, consider joining our team!
Here is your opportunity to join a dynamic team at a diverse company with secure, community roots and an innovative future.
Description
Logistics:
This position will be onsite at 4101 Percival Rd. Columbia, SC 29229. Training hours will be 8:00 a.m. - 4:30 p.m. Monday - Friday. After training the hours will be between 8:00 a.m. - 6:00 p.m. Monday - Friday.
What You'll Do:
Ensure effective customer relations by responding accurately, timely, and courteously to telephone, written, web, or walk-in inquiries.
Handle situations which may require adaptation of response or extensive research.
Identify incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines.
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 refers these to a lead or manager for resolution.
Identify and report potential fraud and abuse situations.
To Qualify for This Position, You'll Need:
High School Diploma or equivalent
Two years of customer service experience including One 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.
We Prefer That You Have:
One year call center experience with claims experience.
What We can Do for You:
401K retirement savings plan with company match
Subsidized health plans, dental and vision coverage
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
What to Expect Next:
After submitting your application, our recruiting team members will review your resume to ensure your meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.
Management will be conducting interviews with the most qualified candidates, with prioritization give to those candidates who demonstrate the preferred qualifications.
We participate in E-Verify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Here's more information.
Equal Employment Opportunity Statement
BlueCross BlueShield of South Carolina and our subsidiary companies maintain a continuing policy of nondiscrimination in employment to promote employment opportunities for persons regardless of age, race, color, national origin, sex, religion, veteran status, disability, weight, sexual orientation, gender identity, genetic information or any other legally protected status. Additionally, as a federal contractor, the company maintains Affirmative Action programs to promote employment opportunities for minorities, females, disabled individuals and veterans. It is our policy to provide equal opportunities in all phases of the employment process and to comply with applicable federal, state and local laws and regulations.
We are committed to working with and providing reasonable accommodations to individuals with physical and mental disabilities.
If you need special assistance or an accommodation while seeking employment, please e-mail [email protected] or call 1-800-288-2227, ext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.
Apply Now