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BlueCross BlueShield of South Carolina · 1 day ago

Claims Customer Service Advocate III

Columbia, SC

Full-time

Onsite

Mid Level

3+ years exp

BlueCross BlueShield of South Carolina is seeking a Claims Customer Service Advocate III to provide prompt and accurate responses to complex customer inquiries. The role involves reviewing and adjudicating complex claims, performing research to resolve inquiries, and maintaining knowledge of procedures to assist in training customer service representatives.

Financial ServicesHealth CareHealth InsuranceInsuranceMedical

Responsibilities

Reviews claims or appeals issues, complaints, and inquiries referred by claims customer service representatives to determine if desk procedures and guidelines were followed. Research to identifying underlying causes and determine ways to prevent and correct such causes. Identifies and reports potential fraud and abuse situations

Researches and responds to complex customer inquiries, ensuring that contract standards and objectives for timeliness, productivity and quality are met. Handles situations that require adaptation of response or extensive research

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

Provide feedback to management regarding customer issues. Maintain accurate records concerning issues. Follow through on complaints until resolved or report to management as needed

Maintain knowledge of procedures and policies. Assist with process improvements by recommending improvements in procedures and policies. Assists in training claims customer service representatives

Qualification

Claims processingCustomer serviceMicrosoft OfficeBusiness mathVerbal communicationWritten communicationConfidentiality

Required

High School Diploma or equivalent

Three years of customer service experience, including one year of claims or appeals processing experience 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 abilities

Ability to handle confidential or sensitive information with discretion

Microsoft Office

Benefits

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 to movies, theaters, zoos, theme parks and more

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