Job Description

Summary
Position Purpose:
In the role as the Claims Customer Service Advocate II, the ideal candidate will be detail-oriented and 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.

Description

Claims Customer Service Advocate II

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\xe2\x80\x99ve 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 \xe2\x80\xa6 and much more. We are one of the nation\xe2\x80\x99s 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 dedicated to the same philosophy, consider joining our team!

Logistics:

This position is full-time position (40 hours per week) Monday through Friday rotating shifts 7:30am \xe2\x80\x93 4:00pm one week and then 8:30am \xe2\x80\x93 5:00pm the next week reporting onsite to 8901 Farrow Road, Columbia, SC 29203.

What You\xe2\x80\x99ll 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 process 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\xe2\x80\x99ll 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

What We can Do for You:

We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.

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

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. If the qualifications require proof of semester hours, please attach your transcript to your application.

Management will be conducting interviews with the most qualified candidates, with prioritization given 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.

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 abilities@bcbssc.com or call 1-800-288-2227, ext. 43172 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a case-by-case basis.

BlueCross BlueShield Of South Carolina