Claims Customer Service Advocate II

Customer Service Representative

This role is part of an inbound call center and directly helps our customers by responding to inquiries that may be non-routine and require deviation from standard screens, scripts and procedures. Research may be required to resolve these inquiries. Other responsibilities include review and adjudication of claims and/or non-medical appeals, determining whether to return, deny or pay claims while following policies and procedures.

Location: This position is full-time (40 hours/week) Monday - Friday in a typical office environment. Employees are required to work a training and work schedule of 8:00am to 4:30pm. It may be necessary, given the business need to work occasional overtime and weekends. This role is located at 4101 Percival Road, Columbia SC.

What You'll Do:

• You'll ensure effective customer relations by responding accurately, timely and courteously to our customers. These responses may be by telephone, written, web or walk-in inquiries. You will handle situations which may require a different set of responses or extensive research. Adhering to department guidelines, you will also identify claims that have been incorrectly processed and will enact process adjustments and reprocessing actions.
• You will examine and process claims and/or non-medical appeals while ensuring business/contract regulations, internal standards and examining guidelines. Another responsibility is to enter claims into the claim system after verifying correct coding of procedures and diagnosis codes. Claims must be processed according to established quality and production standards.
• You'll identify complaints and inquiries that may be complex and that cannot be resolved following usual procedures and guidelines and refer to a team lead or manager for resolution. You will also identify and report fraud and abuse situations.

To Qualify for This Position, You'll Need:

• Required Education: High School Diploma or equivalent
• Required Work Experience: 2 years of customer service experience including 1 year claims or appeals processing OR Bachelor's Degree in lieu of work experience.
• Required Skills and Abilities: 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.
• Required Software and Other Tools: Microsoft Office.

Our Comprehensive Benefits Package Includes the Following

• 401(k) retirement savings plan with company match.
• Subsidized health plans and free vision coverage.
• Life insurance.
• Paid annual leave - the longer you work here, the more you earn.
• Nine paid holidays.
• On-site cafeterias and fitness centers in major locations.
• Wellness programs and a healthy lifestyle premium discount.
• Tuition assistance.
• Service recognition.

What We Can Do for You: We understand the value of a diverse and inclusive workplace and strive to be an employer where employees across all spectrums have the opportunity to develop their skills, advance their careers and contribute their unique abilities to the growth of our company.

What to Expect Next: After submitting your application, our recruiting team members will review your resume to ensure you meet the qualifications. This may include a brief telephone interview or email communication with our recruiter to verify resume specifics and salary requirements.

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 individuals with disabilities and protected 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 disabilities, pregnant individuals, individuals with pregnancy-related conditions, and individuals needing accommodations for sincerely held religious beliefs, provided that those accommodations do not impose an undue hardship on the Company.

If you need special assistance or an accommodation while seeking employment, please email mycareer.help@bcbssc.com or call 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.