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BlueCross BlueShield of South Carolina · 1 week ago

FCMB Claims Customer Service Advocate II

Myrtle Beach, SC

Full-time

Onsite

Entry Level

1+ years exp

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate II responsible for managing routine inquiries related to claims or appeals. The role involves processing claims, identifying errors, and ensuring compliance with established standards while providing excellent customer service.

Financial ServicesHealth CareHealth InsuranceInsuranceMedical

No H1B

Security Clearance Required

U.S. Citizen Only

Responsibilities

Responds to written and/or telephone inquiries according to desk procedures, ensuring that contract standards and objectives for timeliness, productivity, and quality are met. Accurately documents inquiries. Identifies incorrectly processed claims and processes adjustments and reprocessing actions according to department guidelines

Examines and processes claims and/or non-medical appeals according to business/contract regulations, internal standards and examining guidelines. Enters claims into the claim system after verification of correct coding of procedures and diagnosis codes. Ensures claims are processing according to established quality and production standards

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 promptly reports and/or refers suspected fraudulent activities and system errors to the appropriate departments

Qualification

Claims processingCustomer serviceMicrosoft OfficeBusiness mathVerbal communicationWritten communicationConfidentiality

Required

High School Diploma or equivalent

One year of experience in a claims/appeals processing, customer service, or other related support area 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

Microsoft Office

Benefits

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 healthy lifestyle premium discount.

Tuition assistance.

Service recognition.

Incentive Plan.

Merit Plan.

Continuing education funds for additional certifications and certification renewal.

Company

BlueCross BlueShield of South Carolina

Glassdoor3.6

For more than six decades, BlueCross BlueShield of South Carolina has been part of the national landscape. Our roots are firmly embedded in the state.

Founded in 1946

Columbia, South Carolina, USA

10001+ employees