Job title: Claims Customer Service Advocate II
Company: BlueCross BlueShield Of South Carolina
Job description: Summary
We are hiring a Claims Customer Service Advocate II. In this role you will be responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. You will perform research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. In addition, you will determine whether to return, deny or pay claims following organizational policies and procedures.
Description
Position Purpose:
This role 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 reviews and adjudication of claims and/or non-medical appeals, determining whether to return, deny or pay claims while following organizational policies and procedures.
Logistics:
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 during our normal business hours of 7:30 AM EST – 5:00 PM EST. It may necessary, given the business need, to work occasional overtime and weekends. This role is located at 4101 Percival Road in 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.
- 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 can’t be resolved following usual procedures and guidelines and refer these to a team lead or manager for resolution. You will also identify & report potential fraud and abuse situations.
To Qualify for This Position, You’ll Need:
- A high school diploma or equivalent.
- Two years of customer service experience, including one year of claims or appeals processing OR an undergraduate 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.
- Knowledge of Microsoft Office applications.
What We Can Do for You:
You are not alone. We are here to support you.
30 days of classroom and training lab, including:
- Best in class call center training program.
- A classroom environment, live trainer and open discussion.
- A proven curriculum providing the knowledge you need to excel.
- After the initial 30 days of training, there will be a two-week training lab where you take live calls with a trainer or manager close by to answer questions.
Our comprehensive benefits package includes:
- 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 cafeteria and fitness centers in major locations.
- Wellness programs and a healthy lifestyle premium discount.
- Tuition assistance.
- Service recognition.
What to Expect Next:
After submitting your application, our recruiting team 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 and salary requirements.
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.
Some states have required notifications. Here’s
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 mycareer.help@bcbssc.com 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.
Expected salary:
Location: Columbia, SC
Job date: Fri, 08 Mar 2024 08:58:20 GMT
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