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 in a typical office environment. This role is located onsite at 2743 Perimeter Parkway Augusta GA 30909.
What Youll Do:
Ensure effective customer relations by responding accurately timely and courteously to telephone written web or walkin 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 nonmedical 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 processed 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 refer these to a lead or manager for resolution. Identifies and reports potential fraud and abuse situations.
To Qualify For This Position Youll Need The Following:
Required Education: High School Diploma or equivalent
Required Experience: 2 years of customer service experience including 1 year claims or appeals processing OR Bachelors Degree in lieu of work experience.
Required Software and tools: Microsoft Office.
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 handle confidential or sensitive information with discretion.
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
Education Assistance
Service Recognition
National 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.
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 individuals with disabilitiesand protected 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 disabilities pregnant individuals individuals with pregnancyrelated conditions and individuals needing accommodations for sincerely held religious beliefs provided that those accommodations do not impose an undue hardship on the Company.
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.
We participate in EVerify and comply with the Pay Transparency Nondiscrimination Provision. We are an Equal Opportunity Employer. Heres moreinformation.
Some states have required notifications. Heres more information.
Employment Type
Full-Time
