Claims Customer Service Advocate II
Claims Customer Service Advocate II
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Job Description
Summary
Responsible for responding to customer inquiries. Inquiries may be nonroutine and require deviation from standard screens scripts and procedures. Performs research as needed to resolve inquiries. Reviews and adjudicates claims and/or nonmedical appeals. Determines whether to return deny or pay claims following organizational policies and procedures.
Description
Location:
This position is fulltime 40hours/week) MondayFriday. You will work an 8hour flexible shift during the hours of 8:00am 6:00pm in a typical work environment. It may be necessary given the business need to work occasional overtime. You may be required to travel between buildings. Training hours are 8:00am4:30pm MondayFriday for six weeks. This role onsite is located at 4101 Percival Road Columbia SC. 29203.
What Youll Do:
- 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 nonmedical 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.
To Qualify for This Position Youll Need the Following:
- Required Education: High Scholl Diploma or equivalent
- Required Work Experience:
- 1year of experience including 1year claims/appeals processing customer service or other related support area OR bachelors 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.
What Prefer That You Have the Following:
- Associate degree
- 2 yearsof claims processing or call center experience.
- Knowledge of word processing spreadsheet and database software.
Our Comprehensive Benefits Package Includes the Following:
We offer our employees great benefits and rewards. You will be eligible to participate in the benefits the first of the month following 28 days of employment.
- Subsidized health plans dental and vision coverage
- 401K retirement savings plan with company match
- Life Insurance
- Paid Time Off (PTO)
- Onsite 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 We can Do for You:
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.
What to Expect Next:
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.
We participate in EVerify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer.
Some states have required notifications. Heresmore 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 email or callext. 47480 with the nature of your request. We will make a determination regarding your request for reasonable accommodation on a casebycase basis.
Employment Type
Full-Time
