Claims Customer Service Advocate I
Claims Customer Service Advocate I
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Salary Not Disclosed
1 Vacancy
Job Description
Summary
Responsible for responding to routine inquiries. Identifies incorrectly processed claims and completes adjustments and related reprocessing actions. Reviews and adjudicates claims and/or nonmedical appeals. Determines whether to return deny or pay claims following organizational policies and procedures.
Description
Logistics: This position is full time 40 hours/week) MondayFriday from 8:00am 5:30pm EST and will be onsite in Myrtle Beach SC.
- Government Clearance: This position requires the ability to obtain a security clearance which requires applicants to be a U.S. Citizen.
- SCA Benefit Requirements: BlueCross BlueShield of South Carolina and its subsidiary companies have contracts with the federal government subject to the Service Contract Act (SCA). Under the McNamaraOHara Service Contract Act (SCA) employees cannot opt out of health benefits. Employees will receive supplemental pay until they are enrolled in health benefits 28 days after the hire date.
What You Will 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 You Will Need:
- High School Diploma or equivalent
- Oneyear of experience in a claims/appeals processing customer service or other related support area ORBachelors 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
Skills and Abilities:
- Answers phones
- Follows policies and procedures
- Navigates systems
- Processes claims
- Researches inquiries
- Reviews claims and appeals
What We Can Do for You:
- 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.
- Onsite 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.
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
