FCMB Customer Service Advocate II

Claims Processing Representative

Responsible for responding to routine correspondence and telephone inquiries pertaining to claims or appeals. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions.

This position is full-time (40 hours/week) Monday-Friday in a typical office environment. Employees are required to have flexibility to work any of our 8-hour shifts scheduled during hours of 9AM –6PM. Training will be Monday – Friday 8:00 AM - 5:00 PM for approximately 6-8 weeks. This role is located on site at 8733 Highway 17 Bypass, Myrtle Beach SC 29575.

This position requires the ability to obtain a security clearance, which requires applicants to be a U.S. Citizen. BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). As a Service Contract Act (SCA) employee, you are required to enroll in our health insurance, even if you already have other health insurance. Until your enrollment is complete, you will receive supplemental pay for health coverage. Your coverage begins on the first day of the month following 28 days of full-time employment.

Researches and responds to telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Research and respond to written inquiries and identify incorrectly processed claims and complete the adjustment and/or reprocessing action according to department guidelines. This may include initiating, documenting, and processing the request to completion. Initiate recoupments as necessary. 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. Completes projects and/or assignments related to claims processing and customer service functions in the department.

Required Education: A High School Diploma or equivalent. Required Work Experience: 2 years of customer service experience OR 1 year of claims or appeals processing experience and 1 year of customer service experience 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 Manage Confidential or Sensitive Information with Discretion. Required Software and Tools: Microsoft Office.

Our comprehensive benefits package includes the following: 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 on movies, theaters, zoos, theme parks and more.

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. 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. Management will conduct interviews with those candidates who qualify, with prioritization given to those candidates who demonstrate the required qualifications.