Claims Customer Service Advocate II

Summary

Responsible for responding to customer inquiries. Inquiries may be non-routine and require deviation from standard screens, scripts, and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or non-medical appeals. Determines whether to return, deny or pay claims following organizational policies and procedures. Description Logistics: This position will be onsite at 4101 Percival Rd. Columbia, SC 29229 and hours will be 8:00 a.m. - 4:30 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'smore 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 Job!